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NPI Code Detail

MEDICARE: JULIE L DORRELL PTA

MEDICARE: JULIE L DORRELL 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 Assistant2005013267MO

General Provider Information

NPI Number : 1326294992
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE L DORRELL PTA
Provider Business Mailing Address
First Line : 24237 HUSK RD
Second Line :
City : BROOKFIELD
State : MO
Zip : 64628-2364
Country : US
Telephone Number : 615-896-6400
Fax Number :
Provider Business Practice Location Address
First Line : 2601 FAIR ST
Second Line :
City : CHILLICOTHEE
State : MO
Zip : 64601-3525
Country : US
Telephone Number : 615-896-6400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2008
Last Update Date : 08/14/2008

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