Provider Demographics
NPI:1346599800
Name:CABALLERO, JULIE LORRAINE (PTA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LORRAINE
Last Name:CABALLERO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 S OCEAN DR
Mailing Address - Street 2:APT 1708
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-2632
Mailing Address - Country:US
Mailing Address - Phone:954-600-7661
Mailing Address - Fax:
Practice Address - Street 1:2301 S OCEAN DR
Practice Address - Street 2:APT 1708
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-2632
Practice Address - Country:US
Practice Address - Phone:954-600-7661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA0371225200000X
TX2072885225200000X
CA8838225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant