Healthcare Provider Details

I. General information

NPI: 1245908177
Provider Name (Legal Business Name): JULIE LYNN KANE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 12/21/2025
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SIERRA COLLEGE DR
GRASS VALLEY CA
95945-5082
US

IV. Provider business mailing address

PO BOX 236
GRASS VALLEY CA
95945-0236
US

V. Phone/Fax

Practice location:
  • Phone: 530-274-2320
  • Fax:
Mailing address:
  • Phone: 530-274-2320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number10489
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: