Provider Demographics
NPI:1366538688
Name:FREEMAN, JULIE M (PT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:FREEMAN
Suffix:
Gender:F
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:PO BOX 646
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-0646
Mailing Address - Country:US
Mailing Address - Phone:601-444-9200
Mailing Address - Fax:601-444-9090
Practice Address - Street 1:70 COLUMBIA PURVIS ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429
Practice Address - Country:US
Practice Address - Phone:601-444-9200
Practice Address - Fax:601-444-9090
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015385Medicaid
MS256576Medicare Oscar/Certification
MS1912033291OtherGROUP NPI