Healthcare Provider Details

I. General information

NPI: 1205595014
Provider Name (Legal Business Name): MRS. JULIA MESSNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15315 1ST AVE NE
DUVALL WA
98019-5004
US

IV. Provider business mailing address

26837 MAPLE VALLEY BLACK DIAMOND RD SE STE 200
MAPLE VALLEY WA
98038-9917
US

V. Phone/Fax

Practice location:
  • Phone: 425-788-0505
  • Fax: 425-788-3340
Mailing address:
  • Phone: 425-413-4427
  • Fax: 425-413-4402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT61159944
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: