Provider Demographics
NPI:1982935128
Name:BANKS, JULIE ANN (DPT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:BANKS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:DUPONT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:581 BREMERTON PL NE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-5706
Mailing Address - Country:US
Mailing Address - Phone:425-988-4020
Mailing Address - Fax:
Practice Address - Street 1:2445 140TH AVE NE MOSAIC CHILDREN'S THERAPY CLINIC
Practice Address - Street 2:SUITE B105
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005
Practice Address - Country:US
Practice Address - Phone:425-644-6328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60100872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist