Provider Demographics
NPI:1962604967
Name:COOK MAYFIELD, JULIENNE MARIE (DPT)
Entity type:Individual
Prefix:
First Name:JULIENNE
Middle Name:MARIE
Last Name:COOK MAYFIELD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12820 MISSION CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-2760
Mailing Address - Country:US
Mailing Address - Phone:907-250-3932
Mailing Address - Fax:907-802-4529
Practice Address - Street 1:12820 MISSION CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-2760
Practice Address - Country:US
Practice Address - Phone:907-250-3932
Practice Address - Fax:907-802-4529
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015997225100000X
AK1923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
EINOther843080609
AK1696774Medicaid