1639302185 NPI number — JULIE L SECHRIST PT

Table of content: JULIE L SECHRIST PT (NPI 1639302185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639302185 NPI number — JULIE L SECHRIST PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SECHRIST
Provider First Name:
JULIE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639302185
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RR 1 BOX 140C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOWANDA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18848-9787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-265-7688
Provider Business Mailing Address Fax Number:
570-265-7134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RR 3 BOX 500A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16947-9485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-297-2774
Provider Business Practice Location Address Fax Number:
570-297-2864
Provider Enumeration Date:
09/01/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)