Provider Demographics
NPI:1033624309
Name:RICHARD, JULIA RAE
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:RAE
Last Name:RICHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66946 HUNTER RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97876-8128
Mailing Address - Country:US
Mailing Address - Phone:541-963-8512
Mailing Address - Fax:
Practice Address - Street 1:610 SUNSET DR
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-1269
Practice Address - Country:US
Practice Address - Phone:541-963-1437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-08
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist