Provider Demographics
NPI:1669420196
Name:CLAIBORNE, JULIE R (BSPT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:R
Last Name:CLAIBORNE
Suffix:
Gender:F
Credentials:BSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 S 42ND ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7300
Mailing Address - Country:US
Mailing Address - Phone:253-472-7844
Mailing Address - Fax:253-472-8474
Practice Address - Street 1:2702 S 42ND ST
Practice Address - Street 2:SUITE 310
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7300
Practice Address - Country:US
Practice Address - Phone:253-472-7844
Practice Address - Fax:253-472-8474
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005753225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7695CLOtherREGENCE
WA8372682Medicaid
WAAB39543Medicare ID - Type Unspecified
WA7695CLOtherREGENCE