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NPI Code Detail

MEDICARE: JULIE A MISTOVICH PTA

MEDICARE: JULIE A MISTOVICH PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant3768NC

General Provider Information

NPI Number : 1255575676
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE A MISTOVICH PTA
Provider Business Mailing Address
First Line : 4144 HEARTHSIDE DR
Second Line : APT. 201
City : WILMINGTON
State : NC
Zip : 28412-8512
Country : US
Telephone Number : 330-518-5975
Fax Number :
Provider Business Practice Location Address
First Line : 1007 PORTERS NECK RD
Second Line :
City : WILMINGTON
State : NC
Zip : 28411-7383
Country : US
Telephone Number : 910-686-6506
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2009
Last Update Date : 04/29/2009

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