Provider Demographics
NPI:1922000512
Name:YEVCHAK, JULIE A (PT)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:A
Last Name:YEVCHAK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3248 LITHIA PINECREST RD STE 102
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-5682
Mailing Address - Country:US
Mailing Address - Phone:813-662-1366
Mailing Address - Fax:813-662-1159
Practice Address - Street 1:3248 LITHIA PINECREST RD STE 102
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-5682
Practice Address - Country:US
Practice Address - Phone:813-662-1366
Practice Address - Fax:813-662-1159
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8184225100000X
FLPT23572225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD8509OtherMEDCOST
NC079JROtherBCBS NC