Provider Demographics
NPI:1295796274
Name:HUNTER, JULIE LYNN (PT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNN
Last Name:HUNTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:LYNN
Other - Last Name:FUNK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 271429
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-1429
Mailing Address - Country:US
Mailing Address - Phone:602-648-5444
Mailing Address - Fax:
Practice Address - Street 1:3033 N 44TH ST STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7227
Practice Address - Country:US
Practice Address - Phone:602-631-3161
Practice Address - Fax:602-631-3162
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1619225100000X
FLPT12690225100000X
AZ5743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ203645Medicaid
AZP00624802OtherRAILROAD MEDICARE
AZP00624802OtherRAILROAD MEDICARE