MEDICARE: JULIE ANN MECHAM MPT

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	225100000X	Physical Therapist	5649-24	WI

General Provider Information

NPI Number	:	1447743869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE ANN MECHAM MPT

Provider Business Mailing Address
First Line	:	600 52ND ST STE 240
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53140-3423
Country	:	US
Telephone Number	:	888-488-8714
Fax Number	:	262-925-5001

Provider Business Practice Location Address
First Line	:	7200 WASHINGTON AVE STE 103
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53406-6516
Country	:	US
Telephone Number	:	262-583-0790
Fax Number	:	262-583-0768

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

Provider Enumeration Date	:	06/11/2018
Last Update Date	:	06/11/2018

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