Provider Demographics
NPI:1457343865
Name:STAFFAN, JULIE K (MPT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:K
Last Name:STAFFAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 S HAMILTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3311
Mailing Address - Country:US
Mailing Address - Phone:614-471-5442
Mailing Address - Fax:614-471-5462
Practice Address - Street 1:358 S HAMILTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3311
Practice Address - Country:US
Practice Address - Phone:614-471-5442
Practice Address - Fax:614-471-5462
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT10430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2469609Medicaid
OH2469609Medicaid