Provider Demographics
NPI:1922290238
Name:JASTRZEMSKI, JULIE ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:JASTRZEMSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:KUTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1099 FARMERS LOOP RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-6821
Mailing Address - Country:US
Mailing Address - Phone:907-455-4556
Mailing Address - Fax:
Practice Address - Street 1:1919 LATHROP ST STE 222
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5942
Practice Address - Country:US
Practice Address - Phone:907-456-5990
Practice Address - Fax:907-456-7418
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1122225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist