Basic Information
| Provider Information | |||||||||
| NPI: | 1427596584 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPENCER | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | OKAMOTO | ||||||||
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| OtherLastName: | OKAMOTO | ||||||||
| OtherFirstName: | JULIE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 129 S PEBBLE BEACH BLVD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | SUN CITY CENTER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335735718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136336800 | ||||||||
| FaxNumber: | 8136336801 | ||||||||
| Practice Location | |||||||||
| Address1: | 129 S PEBBLE BEACH BLVD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | SUN CITY CENTER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335735718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136336800 | ||||||||
| FaxNumber: | 8136336801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2017 | ||||||||
| LastUpdateDate: | 02/08/2017 | ||||||||
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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 | PT11038 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.