MEDICARE: JULIA BLAKEBURN

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	2306603449	VA

General Provider Information

NPI Number	:	1861256570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA BLAKEBURN

Provider Business Mailing Address
First Line	:	5108 CHAYOTE CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-1982
Country	:	US
Telephone Number	:	757-589-1494
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 SHORE DR
Second Line	:
City	:	VIRGINIA BCH
State	:	VA
Zip	:	23451-1199
Country	:	US
Telephone Number	:	757-496-1100
Fax Number	:

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

Provider Enumeration Date	:	02/13/2024
Last Update Date	:	02/13/2024

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