Healthcare Provider Details

I. General information

NPI: 1053070961
Provider Name (Legal Business Name): JULIAN TURNER LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 RAYMOND DR
SAINT CHARLES MO
63301-4872
US

IV. Provider business mailing address

1431 HERITAGE LNDG APT 101
SAINT CHARLES MO
63303-6580
US

V. Phone/Fax

Practice location:
  • Phone: 636-946-2244
  • Fax: 636-946-6975
Mailing address:
  • Phone: 202-903-8166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2021046972
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: