Provider Demographics
NPI:1730269226
Name:ROSS, JULIE A (PT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:ROSS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:BLUNK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:330 S 5TH ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5825
Mailing Address - Country:US
Mailing Address - Phone:580-233-6707
Mailing Address - Fax:580-233-3724
Practice Address - Street 1:330 S 5TH ST
Practice Address - Street 2:SUITE 501
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5825
Practice Address - Country:US
Practice Address - Phone:580-233-6707
Practice Address - Fax:580-233-3724
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT1439174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
249501102Medicare ID - Type Unspecified