Provider Demographics
NPI:1205350568
Name:SMITH, JULIA (PT)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:BREARLEY
Other - Last Name:GUERRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11759 BAYFIELD CT
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194-1814
Mailing Address - Country:US
Mailing Address - Phone:804-658-6148
Mailing Address - Fax:
Practice Address - Street 1:5900 FORT DR STE 208
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2425
Practice Address - Country:US
Practice Address - Phone:703-830-6360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist