Basic Information
| Provider Information | |||||||||
| NPI: | 1053516427 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | EVERETT | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 BAINBRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191471568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156293837 | ||||||||
| FaxNumber: | 2156295531 | ||||||||
| Practice Location | |||||||||
| Address1: | 1616 WALNUT ST | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191035313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155458717 | ||||||||
| FaxNumber: | 2155459355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2007 | ||||||||
| LastUpdateDate: | 04/14/2008 | ||||||||
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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 | 22336 | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 121790SAV | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.