Provider Demographics
NPI:1316156516
Name:RUBY, JULIE ROSE (LAC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ROSE
Last Name:RUBY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ROSE
Other - Last Name:RUBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICENSED ACUPUNCTURI
Mailing Address - Street 1:8136 OLD KEENE MILL RD
Mailing Address - Street 2:SUITE B-218
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1850
Mailing Address - Country:US
Mailing Address - Phone:703-975-0475
Mailing Address - Fax:703-451-8281
Practice Address - Street 1:8136 OLD KEENE MILL RD
Practice Address - Street 2:SUITE B-218
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1850
Practice Address - Country:US
Practice Address - Phone:703-975-0475
Practice Address - Fax:703-451-8281
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000024171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist