Healthcare Provider Details

I. General information

NPI: 1184669863
Provider Name (Legal Business Name): JULIE M DEMAREST PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 WINDING WAY
MOBILE AL
36693-2918
US

IV. Provider business mailing address

4320 WINDING WAY
MOBILE AL
36693-2918
US

V. Phone/Fax

Practice location:
  • Phone: 251-666-2906
  • Fax:
Mailing address:
  • Phone: 251-666-2906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number3143
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: