Provider Demographics
NPI:1396745543
Name:WADDELL, JULIE K (PT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:K
Last Name:WADDELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:K
Other - Last Name:ANDERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1105 27TH ST
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2710
Mailing Address - Country:US
Mailing Address - Phone:360-855-7536
Mailing Address - Fax:
Practice Address - Street 1:1105 27TH ST
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2710
Practice Address - Country:US
Practice Address - Phone:360-855-7536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7155104Medicaid
P06560Medicare UPIN
WA7155104Medicaid