Provider Demographics
NPI:1306163761
Name:COLLISON, JULIE (PT)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:COLLISON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:MAURER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1142 ORLANDO DR
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-9484
Mailing Address - Country:US
Mailing Address - Phone:920-339-0700
Mailing Address - Fax:920-330-0278
Practice Address - Street 1:1409 SWAMP RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-1475
Practice Address - Country:US
Practice Address - Phone:920-339-0700
Practice Address - Fax:920-330-0278
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11405-0242251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics