Healthcare Provider Details

I. General information

NPI: 1215218409
Provider Name (Legal Business Name): JULIANNA MIX PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 S WADSWORTH BLVD SUITE 303
LAKEWOOD CO
80227-3273
US

IV. Provider business mailing address

5712 W SUMAC AVE
LITTLETON CO
80123-0686
US

V. Phone/Fax

Practice location:
  • Phone: 720-962-4555
  • Fax: 720-962-4466
Mailing address:
  • Phone: 303-734-8564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: