Provider Demographics
NPI:1295894228
Name:ENDRESON, JULIE (ATC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:ENDRESON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104C OLD LAS VEGAS HWY
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-8199
Mailing Address - Country:US
Mailing Address - Phone:505-992-4995
Mailing Address - Fax:505-992-4985
Practice Address - Street 1:104C OLD LAS VEGAS HWY
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-8199
Practice Address - Country:US
Practice Address - Phone:505-992-4995
Practice Address - Fax:505-992-4985
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-71225200000X
NM792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer