Provider Demographics
NPI:1861806374
Name:MANDLI, JULIE ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:MANDLI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HIGHLAND AVE
Mailing Address - Street 2:MAIL STOP 2424
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53792-2424
Mailing Address - Country:US
Mailing Address - Phone:608-263-8060
Mailing Address - Fax:608-262-7679
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:MAIL STOP 2424
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-2424
Practice Address - Country:US
Practice Address - Phone:608-263-8060
Practice Address - Fax:608-262-7679
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4279-242251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics