Provider Demographics
NPI:1174041065
Name:FAWSON, JULIE ANN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:FAWSON
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:143 SHUBIN WAY
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-7622
Mailing Address - Country:US
Mailing Address - Phone:916-838-8235
Mailing Address - Fax:
Practice Address - Street 1:143 SHUBIN WAY
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-7622
Practice Address - Country:US
Practice Address - Phone:916-838-8235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA249652251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty