Basic Information
Provider Information
NPI: 1548572423
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HALL
FirstName: JULIE
MiddleName: N
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 120 WILLIAM PENN PLZ
Address2:  
City: DURHAM
State: NC
PostalCode: 277042150
CountryCode: US
TelephoneNumber: 9192205255
FaxNumber: 9193131276
Practice Location
Address1: 107 E MCCLANAHAN ST
Address2:  
City: OXFORD
State: NC
PostalCode: 275652919
CountryCode: US
TelephoneNumber: 9196908500
FaxNumber: 9196030545
Other Information
ProviderEnumerationDate: 07/08/2010
LastUpdateDate: 01/16/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X34020CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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