Provider Demographics
NPI:1194062711
Name:JANDA, JULIE (LMP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:JANDA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 371
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:WA
Mailing Address - Zip Code:98305-0371
Mailing Address - Country:US
Mailing Address - Phone:360-327-3824
Mailing Address - Fax:
Practice Address - Street 1:260 TYEE RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WA
Practice Address - Zip Code:98305
Practice Address - Country:US
Practice Address - Phone:360-327-3824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60327959225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist