Healthcare Provider Details

I. General information

NPI: 1851043061
Provider Name (Legal Business Name): JULIE MARIE DEYOUNG DPT, OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 01/20/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 N MEDICAL CENTER DR W STE 121
CLOVIS CA
93611-6880
US

IV. Provider business mailing address

1848 N CARSON AVE
CLOVIS CA
93619-7412
US

V. Phone/Fax

Practice location:
  • Phone: 559-324-4057
  • Fax:
Mailing address:
  • Phone: 559-230-9801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number29948
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: