=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770026775
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE COUNTRYMAN NEUSHUL MS, DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2016
-----------------------------------------------------
Last Update Date | 11/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2063 SAN ELIJO AVE SUITE 2063
-----------------------------------------------------
City | CARDIFF
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92007-1726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-692-4735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4405 SUNNYHILL DR
-----------------------------------------------------
City | CARLSBAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92008-3662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-805-9419
-----------------------------------------------------
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 | PT 19747
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------