Provider Demographics
NPI:1487703823
Name:DOOR, JULIE LB (LMP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:LB
Last Name:DOOR
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 S MERIDIAN
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-1553
Mailing Address - Country:US
Mailing Address - Phone:253-841-6482
Mailing Address - Fax:253-864-0148
Practice Address - Street 1:2401 S MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-1553
Practice Address - Country:US
Practice Address - Phone:253-841-6482
Practice Address - Fax:253-864-0148
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022950225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist