Provider Demographics
NPI:1720580004
Name:WEST, JULIA (ATC)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:ROWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:746 122ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-3107
Mailing Address - Country:US
Mailing Address - Phone:631-346-7543
Mailing Address - Fax:
Practice Address - Street 1:3303 33RD AVE NE
Practice Address - Street 2:
Practice Address - City:ST ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418-1704
Practice Address - Country:US
Practice Address - Phone:612-706-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer