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General NPI Number Information
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NPI Number | 1356024913
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Entity Type | Individual
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Provider Name | JULIE MARIE STACK
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Gender | Female
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Dates
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Enumeration Date | 08/10/2023
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 710 BUFFALO ST
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City | CORPUS CHRISTI
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State | TX
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Zip | 78401-1933
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Country | US
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Telephone | 888-364-9695
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Fax |
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Provider Business Mailing Address
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Address Line | 109 SUN HARBOR ST
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City | ROCKPORT
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State | TX
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Zip | 78382-7787
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Country | US
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Telephone | 832-451-0141
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2158519
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License Number State | TX
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