Basic Information
| Provider Information | |||||||||
| NPI: | 1316080328 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DECUIRE | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | A | ||||||||
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| OtherLastName: | SKELTON | ||||||||
| OtherFirstName: | JULIE | ||||||||
| OtherMiddleName: | ANN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1519 132ND ST SE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982087203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253300633 | ||||||||
| FaxNumber: | 4253389637 | ||||||||
| Practice Location | |||||||||
| Address1: | 22500 NE MARKETPLACE DR | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | REDMOND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980532033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258361034 | ||||||||
| FaxNumber: | 4258361037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2007 | ||||||||
| LastUpdateDate: | 01/25/2012 | ||||||||
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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 | PT00008629 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0218066 | 01 | WA | DEPT. OF LABOR & INDUSTRY | OTHER | 3499DE | 01 | WA | REGENCE | OTHER | 7762900 | 01 | WA | AETNA | OTHER | 0232275 | 01 | WA | LABOR & INDUSTRIES | OTHER | 8943763 | 01 | WA | L&I CRIME VICTIMS | OTHER | P00417127 | 01 | WA | RAILROAD MEDIARE | OTHER | G8872199 | 01 | WA | MEDICARE | OTHER | 2250DE | 01 | WA | REGENCE BLUE SHIELD | OTHER | 8474595 | 05 | WA | MEDICAID | 8870905 | 01 | WA | MEDICARE | OTHER | P00473358 | 01 | WA | RAILROAD MEDICARE | OTHER |