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NPI Code Detail

MEDICARE: JULIE SURDAL DPT

MEDICARE: JULIE SURDAL DPT
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
1225100000XPhysical TherapistMO1999135163MO

General Provider Information

NPI Number : 1689962490
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE SURDAL DPT
Provider Business Mailing Address
First Line : 18691 OLD HIGHWAY 63 N
Second Line :
City : STURGEON
State : MO
Zip : 65284-9145
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 200 SOUTH ST
Second Line :
City : PARIS
State : MO
Zip : 65275-1165
Country : US
Telephone Number : 660-327-4125
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2011
Last Update Date : 07/13/2011

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