Healthcare Provider Details

I. General information

NPI: 1518925353
Provider Name (Legal Business Name): JULIE A BLANK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIE A. HALL PT

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5968 CLARK CENTER AVE
SARASOTA FL
34238-2715
US

IV. Provider business mailing address

5968 CLARK CENTER AVE
SARASOTA FL
34238-2715
US

V. Phone/Fax

Practice location:
  • Phone: 941-922-8200
  • Fax: 941-343-9402
Mailing address:
  • Phone: 941-922-8200
  • Fax: 941-343-9402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19653
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: