Provider Demographics
NPI:1104963461
Name:KRAUSE, JULIA (MPT)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12572 VALLEY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2006
Mailing Address - Country:US
Mailing Address - Phone:714-823-4400
Mailing Address - Fax:714-823-4404
Practice Address - Street 1:11021 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-1001
Practice Address - Country:US
Practice Address - Phone:714-399-1111
Practice Address - Fax:714-399-1130
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA16059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT16059OtherMEDICARE PTAN