Provider Demographics
NPI:1043625593
Name:FARIAS, JULIANE
Entity Type:Individual
Prefix:
First Name:JULIANE
Middle Name:
Last Name:FARIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BELLINGHAM AVENUE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149
Mailing Address - Country:US
Mailing Address - Phone:857-453-0753
Mailing Address - Fax:
Practice Address - Street 1:20 BELLINGHAM AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-1219
Practice Address - Country:US
Practice Address - Phone:857-453-0753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist