Provider Demographics
NPI:1013184688
Name:VEGA, JULIO A JR (PT)
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:A
Last Name:VEGA
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 DRYSTACK WAY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8727
Mailing Address - Country:US
Mailing Address - Phone:315-395-0472
Mailing Address - Fax:315-461-9795
Practice Address - Street 1:421 DRYSTACK WAY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8727
Practice Address - Country:US
Practice Address - Phone:315-395-0472
Practice Address - Fax:315-461-9795
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018490-1225100000X
NC132982251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist