Provider Demographics
NPI:1770746570
Name:SULLENS, JULIE S (DPT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:S
Last Name:SULLENS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4446 RIVERCLIFF WAY
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-3875
Mailing Address - Country:US
Mailing Address - Phone:706-767-4995
Mailing Address - Fax:
Practice Address - Street 1:4446 RIVERCLIFF WAY
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032-3875
Practice Address - Country:US
Practice Address - Phone:706-767-4995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009351225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist