Provider Demographics
NPI:1720359722
Name:JULIA, MARY ANN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:JULIA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14030 CITRUS WAY
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-8423
Mailing Address - Country:US
Mailing Address - Phone:352-650-6835
Mailing Address - Fax:352-799-6039
Practice Address - Street 1:14030 CITRUS WAY
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-8423
Practice Address - Country:US
Practice Address - Phone:352-650-6835
Practice Address - Fax:352-799-6039
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19482225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant