Provider Demographics
NPI:1700930963
Name:TINDALL, JULIE L (PT PHYSICAL THERAPIS)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:L
Last Name:TINDALL
Suffix:
Gender:F
Credentials:PT PHYSICAL THERAPIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15810 S 45TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048
Mailing Address - Country:US
Mailing Address - Phone:480-893-1321
Mailing Address - Fax:480-893-3148
Practice Address - Street 1:15810 S 45TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048
Practice Address - Country:US
Practice Address - Phone:480-893-1321
Practice Address - Fax:480-893-3148
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5403659OtherAETNA
2Z0482OtherHEALTHNET
0462920OtherBCBS
5403659OtherAETNA
0462920OtherBCBS