Healthcare Provider Details

I. General information

NPI: 1760435408
Provider Name (Legal Business Name): JULIE STAUB PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 SUZANNE WAY STE 200
EUGENE OR
97408-7619
US

IV. Provider business mailing address

25861 FLECK RD
VENETA OR
97487-9547
US

V. Phone/Fax

Practice location:
  • Phone: 541-228-3130
  • Fax: 541-228-3187
Mailing address:
  • Phone: 541-935-4966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3494
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: