Provider Demographics
NPI:1003807561
Name:GIULIETTI, JEFF A (MPT, ATC)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:A
Last Name:GIULIETTI
Suffix:
Gender:M
Credentials:MPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 OAKWAY CTR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5645
Mailing Address - Country:US
Mailing Address - Phone:541-687-7005
Mailing Address - Fax:541-687-7006
Practice Address - Street 1:54 OAKWAY CTR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5645
Practice Address - Country:US
Practice Address - Phone:541-687-7005
Practice Address - Fax:541-687-7006
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR069257Medicaid
OR116876Medicare ID - Type UnspecifiedMEDICARE