Provider Demographics
NPI:1518365139
Name:HAVELKA, JULIE MICHELE (PTA)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:MICHELE
Last Name:HAVELKA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:MICHELE
Other - Last Name:PAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4601 BRYCE DR
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-3235
Mailing Address - Country:US
Mailing Address - Phone:360-320-5880
Mailing Address - Fax:
Practice Address - Street 1:501 8TH ST.
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-3520
Practice Address - Country:US
Practice Address - Phone:360-532-0544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-12
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPTA10195225200000X
WAP160326080225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant