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General NPI Number Information
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NPI Number | 1255815841
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Entity Type | Individual
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Provider Name | JULIE ALEXANDRA TAN PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 09/19/2018
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Last Update Date | 09/19/2018
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Provider Practice Location Address
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Address Line | 12246 MIRAMAR PKWY
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City | MIRAMAR
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State | FL
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Zip | 33025-7016
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Country | US
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Telephone | 954-559-5344
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Fax |
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Provider Business Mailing Address
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Address Line | 11860 NW 13TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-4347
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Country | US
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Telephone | 954-559-5344
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | PT27882
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License Number State | FL
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