Healthcare Provider Details

I. General information

NPI: 1285115683
Provider Name (Legal Business Name): JULIE KUCHEM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE SECRIST

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E MAIN ST
ALICE TX
78332-4261
US

IV. Provider business mailing address

10113 UP RIVER RD APT 5304
CORPUS CHRISTI TX
78410-1605
US

V. Phone/Fax

Practice location:
  • Phone: 361-661-8130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1292409
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: