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General NPI Number Information
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NPI Number | 1568621217
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Entity Type | Individual
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Provider Name | SAMANTHA LEIGH JULIAS A.T.C.
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Gender | Female
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Dates
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Enumeration Date | 06/07/2008
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Last Update Date | 06/07/2008
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Provider Practice Location Address
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Address Line | 365 BILL FRANCE BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-1301
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Country | US
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Telephone | 386-323-5840
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Fax |
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Provider Business Mailing Address
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Address Line | 6710 N PARAQUA CIR
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City | CRYSTAL RIVER
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State | FL
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Zip | 34428-6696
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Country | US
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Telephone | 352-613-7703
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL 2480
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License Number State | FL
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