MEDICARE: JULIE MARIE BRASHER PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA006094	OH

General Provider Information

NPI Number	:	1043979578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE MARIE BRASHER PTA

Provider Business Mailing Address
First Line	:	309 1/2 E FRANKLIN ST
Second Line	:
City	:	CIRCLEVILLE
State	:	OH
Zip	:	43113-1832
Country	:	US
Telephone Number	:	937-710-3874
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 OLENTANGY RIVER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3450
Country	:	US
Telephone Number	:	844-570-5714
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2021
Last Update Date	:	12/13/2021

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