Provider Demographics
NPI:1811157951
Name:ELIZONDO, JULIA A (PT, OCS)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:A
Last Name:ELIZONDO
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Gender:F
Credentials:PT, OCS
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Mailing Address - Street 1:4341 BIRCH STREET
Mailing Address - Street 2:SUITE #102 SELECTIVE REHAB
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-250-7870
Mailing Address - Fax:949-475-1003
Practice Address - Street 1:4341 BIRCH STREET
Practice Address - Street 2:SUITE #102 SELECTIVE REHAB
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-250-7870
Practice Address - Fax:949-475-1003
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2009-06-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA15574225100000X
CAPT15574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist