Provider Demographics
NPI:1275151201
Name:BERGERIA, JULIANNE (DPT)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:BERGERIA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 PICKETT ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-2604
Mailing Address - Country:US
Mailing Address - Phone:203-470-6009
Mailing Address - Fax:
Practice Address - Street 1:5254 POTOMAC DR STE A
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-5832
Practice Address - Country:US
Practice Address - Phone:203-470-6009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01273500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist