Healthcare Provider Details

I. General information

NPI: 1205839123
Provider Name (Legal Business Name): JULIE L SCARPACE P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 MCINGVALE RD STE J
HERNANDO MS
38632-8696
US

IV. Provider business mailing address

2670 MCINGVALE RD STE J
HERNANDO MS
38632-8696
US

V. Phone/Fax

Practice location:
  • Phone: 662-548-2710
  • Fax: 662-548-2711
Mailing address:
  • Phone: 662-548-2710
  • Fax: 662-548-2711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0000003964
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP028295T
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: