Provider Demographics
NPI:1568587525
Name:JUNTILLA, ULYSSES SACAY (PT)
Entity Type:Individual
Prefix:MR
First Name:ULYSSES
Middle Name:SACAY
Last Name:JUNTILLA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4427 BLOSSOM ST
Mailing Address - Street 2:APT N7
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-3661
Mailing Address - Country:US
Mailing Address - Phone:803-338-1428
Mailing Address - Fax:
Practice Address - Street 1:4427 BLOSSOM ST
Practice Address - Street 2:APT N7
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-3661
Practice Address - Country:US
Practice Address - Phone:803-338-1428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist