Healthcare Provider Details

I. General information

NPI: 1932293792
Provider Name (Legal Business Name): JULIANNA B BROOKSHIRE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E ROOSEVELT BLVD SUITE 200A
MONROE NC
28112-5170
US

IV. Provider business mailing address

PO BOX 5001
MONROE NC
28111-5001
US

V. Phone/Fax

Practice location:
  • Phone: 704-289-4595
  • Fax: 704-220-1005
Mailing address:
  • Phone: 704-289-4595
  • Fax: 704-220-1005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9096
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: