Provider Demographics
NPI:1215167671
Name:SERGENT, JULIE NICOLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:NICOLE
Last Name:SERGENT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 HEATHER GREEN BLVD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-6722
Mailing Address - Country:US
Mailing Address - Phone:502-802-0156
Mailing Address - Fax:
Practice Address - Street 1:2801 HEATHER GREEN BLVD
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-6722
Practice Address - Country:US
Practice Address - Phone:502-802-0156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005404225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist