=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477448744
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIA CHRISTINE AZURE PT, DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2025
-----------------------------------------------------
Last Update Date | 08/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1405 MILL ST
-----------------------------------------------------
City | NEW LONDON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54961-2155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-531-2400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6618 PHEASANT RUN
-----------------------------------------------------
City | LINO LAKES
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55014-1331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-367-4473
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 13901
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 17380
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------