Provider Demographics
NPI:1376540054
Name:QUEZON, JULIUS O (PT,CPED)
Entity Type:Individual
Prefix:MR
First Name:JULIUS
Middle Name:O
Last Name:QUEZON
Suffix:
Gender:M
Credentials:PT,CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 S WASHINGTON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-3805
Mailing Address - Country:US
Mailing Address - Phone:765-662-9905
Mailing Address - Fax:765-662-9915
Practice Address - Street 1:119 S WASHINGTON ST
Practice Address - Street 2:SUITE B
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-3805
Practice Address - Country:US
Practice Address - Phone:765-662-9905
Practice Address - Fax:765-662-9915
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003364-A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN189420-BMedicare ID - Type UnspecifiedMEDICARE PROVIDER #
INS-95655Medicare UPIN