1982955464 NPI number — MS. JULIA LEA ADELSON P.T.

Table of content: MS. JULIA LEA ADELSON P.T. (NPI 1982955464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982955464 NPI number — MS. JULIA LEA ADELSON P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADELSON
Provider First Name:
JULIA
Provider Middle Name:
LEA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADELSON
Provider Other First Name:
JULIA
Provider Other Middle Name:
LEA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHYSICAL THERAPIST
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1982955464
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2448 E 26TH PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74114-4302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-743-9182
Provider Business Mailing Address Fax Number:
918-744-1596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4612 S HARVARD AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74135-2908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-744-1331
Provider Business Practice Location Address Fax Number:
918-744-1596
Provider Enumeration Date:
09/25/2012

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 , with the licence number:  1999 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1999 . This is a "STATE LICENSE NUMBER 1999" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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