Provider Demographics
NPI:1295844488
Name:JIMERSON-WILLIAMS, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:JIMERSON-WILLIAMS
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 1:3016 SW SADDLEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-3826
Mailing Address - Country:US
Mailing Address - Phone:816-304-7442
Mailing Address - Fax:
Practice Address - Street 1:2301 S STATE ROUTE 291
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-1201
Practice Address - Country:US
Practice Address - Phone:816-373-9328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO119742OtherLICENSE #