Provider Demographics
NPI:1740307727
Name:MATTOX, JULIE A (ATC)
Entity type:Individual
Prefix:MISS
First Name:JULIE
Middle Name:A
Last Name:MATTOX
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12901 NE 28TH ST APT 125
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-1228
Mailing Address - Country:US
Mailing Address - Phone:360-892-0172
Mailing Address - Fax:
Practice Address - Street 1:12901 NE 28TH ST APT 125
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-1228
Practice Address - Country:US
Practice Address - Phone:360-892-0172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-10097862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer