Provider Demographics
NPI:1861624512
Name:ORNELAS, JULIE LYNN (MS)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNN
Last Name:ORNELAS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:LYNN
Other - Last Name:ORNELAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:4138 N MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2321
Mailing Address - Country:US
Mailing Address - Phone:970-412-7901
Mailing Address - Fax:
Practice Address - Street 1:4138 N MONROE AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2321
Practice Address - Country:US
Practice Address - Phone:970-412-7901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO79953816Medicaid