Provider Demographics
NPI:1225826399
Name:PENA, JULIE ANN (PT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:PENA
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8509 ARDENNES DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4402
Mailing Address - Country:US
Mailing Address - Phone:317-679-7605
Mailing Address - Fax:
Practice Address - Street 1:757 E 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1803
Practice Address - Country:US
Practice Address - Phone:317-967-8787
Practice Address - Fax:317-316-0049
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004036A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist