Healthcare Provider Details

I. General information

NPI: 1184127375
Provider Name (Legal Business Name): JULIA ANN TUTTLE ATC, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF NEBRASKA ATHLETIC MEDICINE ONE MEMORIAL STADIUM
LINCOLN NE
68588
US

IV. Provider business mailing address

UNIVERSITY OF NEBRASKA ATHLETIC MEDICINE ONE MEMORIAL STADIUM
LINCOLN NE
68588
US

V. Phone/Fax

Practice location:
  • Phone: 402-472-2276
  • Fax: 402-472-2006
Mailing address:
  • Phone: 402-472-2276
  • Fax: 402-472-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number426
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: