Basic Information
| Provider Information | |||||||||
| NPI: | 1558814152 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | BROOKE | ||||||||
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| Credential: | D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3019 GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322104407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047180529 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1564 KINGSLEY AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320734521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046448911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2016 | ||||||||
| LastUpdateDate: | 07/31/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 31765 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.