Provider Demographics
NPI:1225394869
Name:PIERCE, JULIE BASIL (LMT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:BASIL
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 BELLEVUE AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-3990
Mailing Address - Country:US
Mailing Address - Phone:401-662-3393
Mailing Address - Fax:
Practice Address - Street 1:174 BELLEVUE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-3990
Practice Address - Country:US
Practice Address - Phone:401-662-3393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI1143174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist