Provider Demographics
NPI:1134271307
Name:ROBERTS, JULIE ELAINE (LMP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ELAINE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8619 20TH ST SE
Mailing Address - Street 2:A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98205-2316
Mailing Address - Country:US
Mailing Address - Phone:435-931-7303
Mailing Address - Fax:
Practice Address - Street 1:2920 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3930
Practice Address - Country:US
Practice Address - Phone:425-931-7303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA13187225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist