Provider Demographics
NPI:1922473487
Name:STEELE, JULIE (PTA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:STEELE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 RUTH JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-2320
Mailing Address - Country:US
Mailing Address - Phone:706-254-2924
Mailing Address - Fax:
Practice Address - Street 1:1821 RUTH JACKSON RD
Practice Address - Street 2:
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-2320
Practice Address - Country:US
Practice Address - Phone:706-254-2924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA000744225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant