MEDICARE: JULIANNA MIX 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

General Provider Information

NPI Number	:	1215218409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANNA MIX PTA

Provider Business Mailing Address
First Line	:	5712 W SUMAC AVE
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80123-0686
Country	:	US
Telephone Number	:	303-734-8564
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 S WADSWORTH BLVD
Second Line	:	SUITE 303
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-3273
Country	:	US
Telephone Number	:	720-962-4555
Fax Number	:	720-962-4466

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

Provider Enumeration Date	:	09/01/2011
Last Update Date	:	09/01/2011

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