Provider Demographics
NPI:1316182082
Name:JULIANO, REBECCA (MSPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:JULIANO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:LAROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:270 FARMINGTON AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1909
Mailing Address - Country:US
Mailing Address - Phone:860-409-4595
Mailing Address - Fax:860-409-4860
Practice Address - Street 1:27 DEPOT ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2601
Practice Address - Country:US
Practice Address - Phone:860-274-1487
Practice Address - Fax:860-274-9730
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007173225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist