Basic Information
Provider Information
NPI: 1003006909
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PINKHAM
FirstName: JULIA
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: L.M.T., L.AC.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: GONZALEZ
OtherFirstName: JULIA
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 2170 RIVERSIDE DR
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432214076
CountryCode: US
TelephoneNumber: 6144867525
FaxNumber: 6144884736
Practice Location
Address1: 2170 RIVERSIDE DR
Address2:  
City: COLUMBUS
State: OH
PostalCode: 43221
CountryCode: US
TelephoneNumber: 6144867525
FaxNumber: 6144884736
Other Information
ProviderEnumerationDate: 07/26/2007
LastUpdateDate: 06/25/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171100000X118OHY Other Service ProvidersAcupuncturist 
225700000X13564OHN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist 

No ID Information.


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