Provider Demographics
NPI:1295471738
Name:MARCELLIANO, JULIE LAUREN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:LAUREN
Last Name:MARCELLIANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 AUDUBON DR
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-1302
Mailing Address - Country:US
Mailing Address - Phone:973-945-2042
Mailing Address - Fax:
Practice Address - Street 1:12-22 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-3660
Practice Address - Country:US
Practice Address - Phone:973-731-8588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA0197300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist