Provider Demographics
NPI:1700093648
Name:DUBRAVETZ, JULIE DAWN (LMT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:DAWN
Last Name:DUBRAVETZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3458
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-0016
Mailing Address - Country:US
Mailing Address - Phone:206-718-2811
Mailing Address - Fax:
Practice Address - Street 1:545 RAINIER BLVD N
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2806
Practice Address - Country:US
Practice Address - Phone:206-718-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009296174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist