Healthcare Provider Details

I. General information

NPI: 1447599709
Provider Name (Legal Business Name): JULIA BLAIR VOYLES ATC,MS,LAT,CES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 BROADWAY
MERRILLVILLE IN
46410-2617
US

IV. Provider business mailing address

301 BROWN ST A
VALPARAISO IN
46383-5586
US

V. Phone/Fax

Practice location:
  • Phone: 219-887-5281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36001576A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096.002768
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: