Provider Demographics
NPI:1093353211
Name:SOCCIO, JULIA LAUREN
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:LAUREN
Last Name:SOCCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:LAUREN
Other - Last Name:SOCCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 412
Mailing Address - Street 2:
Mailing Address - City:GLEN
Mailing Address - State:NH
Mailing Address - Zip Code:03838-0412
Mailing Address - Country:US
Mailing Address - Phone:315-396-8616
Mailing Address - Fax:
Practice Address - Street 1:29 PROVIDENCE AVE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-3199
Practice Address - Country:US
Practice Address - Phone:603-752-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist