Provider Demographics
NPI:1093832040
Name:BERNSTEIN, JULIE ROSE (ATC)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ROSE
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:ROSE
Other - Last Name:HANNUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:245 SUNNYRIDGE AVE
Mailing Address - Street 2:UNIT 34
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-4604
Mailing Address - Country:US
Mailing Address - Phone:203-256-7507
Mailing Address - Fax:
Practice Address - Street 1:35 BEACHSIDE AVE.
Practice Address - Street 2:
Practice Address - City:GREENS FARMS
Practice Address - State:CT
Practice Address - Zip Code:06838-0998
Practice Address - Country:US
Practice Address - Phone:203-256-7507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0002032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer