Provider Demographics
NPI:1598889313
Name:BURNS, JULIETA LOPEZ
Entity Type:Individual
Prefix:
First Name:JULIETA
Middle Name:LOPEZ
Last Name:BURNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIETA
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1625 CAPADARO CT
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-3402
Mailing Address - Country:US
Mailing Address - Phone:719-641-1302
Mailing Address - Fax:
Practice Address - Street 1:1625 CAPADARO CT
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-3402
Practice Address - Country:US
Practice Address - Phone:719-641-1302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL9348171W00000X
CO9348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171W00000XOther Service ProvidersContractor