Provider Demographics
NPI:1922207224
Name:GROOMS, JULIE FAULK (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:FAULK
Last Name:GROOMS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 W MARION ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-2421
Mailing Address - Country:US
Mailing Address - Phone:843-669-9958
Mailing Address - Fax:
Practice Address - Street 1:617 W MARION ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-2421
Practice Address - Country:US
Practice Address - Phone:843-669-9958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist