Provider Demographics
NPI:1437398856
Name:GRANOVITZ, JULIA LEE (PT)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:LEE
Last Name:GRANOVITZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16260 VENTURA BLVD
Mailing Address - Street 2:STE 600
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2203
Mailing Address - Country:US
Mailing Address - Phone:818-986-1977
Mailing Address - Fax:
Practice Address - Street 1:15216 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3601
Practice Address - Country:US
Practice Address - Phone:818-986-1905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 10383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist