Provider Demographics
NPI:1093500746
Name:SERRA, JULIA (LMT, CMLDT)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:SERRA
Suffix:
Gender:
Credentials:LMT, CMLDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1785 PRITCHETT PL
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-1226
Mailing Address - Country:US
Mailing Address - Phone:541-731-0566
Mailing Address - Fax:
Practice Address - Street 1:704 E WHITEAKER AVE
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-1652
Practice Address - Country:US
Practice Address - Phone:458-245-6746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28588225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist