=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487999520
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE COLLIER P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2012
-----------------------------------------------------
Last Update Date | 11/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6239 N MORGAN ST
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22312-5508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-354-0365
-----------------------------------------------------
Fax | 703-354-0365
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6239 N MORGAN ST
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22312-5508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-354-0365
-----------------------------------------------------
Fax | 703-354-0365
-----------------------------------------------------
=====================================================
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 | 2305002669
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------