Provider Demographics
NPI:1396937124
Name:PATE, JULIE LAROCQUE (PT)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:LAROCQUE
Last Name:PATE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:LAROCQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:800 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:CARRINGTON
Mailing Address - State:ND
Mailing Address - Zip Code:58421-1217
Mailing Address - Country:US
Mailing Address - Phone:701-652-7179
Mailing Address - Fax:701-652-2884
Practice Address - Street 1:800 4TH ST N
Practice Address - Street 2:
Practice Address - City:CARRINGTON
Practice Address - State:ND
Practice Address - Zip Code:58421-1217
Practice Address - Country:US
Practice Address - Phone:701-652-7179
Practice Address - Fax:701-652-2884
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist