Individual
JULIE ANN PETRUSHAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2876 LAKE SILVER RD, CRESTVIEW, FL 32536-7161
(850) 902-7624
Mailing address
2876 LAKE SILVER RD, CRESTVIEW, FL 32536-7161
(850) 902-7624
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
06/18/2018
Last updated
06/18/2018
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