Provider Demographics
NPI:1467107110
Name:ST GERMAIN, JULIET MICHAEL (PT)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:MICHAEL
Last Name:ST GERMAIN
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 1:2828 ESPANOLA ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3523
Mailing Address - Country:US
Mailing Address - Phone:505-249-8284
Mailing Address - Fax:
Practice Address - Street 1:2044 OLD MIDDLEFIELD WAY
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-2402
Practice Address - Country:US
Practice Address - Phone:650-260-4743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301759225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist