Provider Demographics
NPI:1639784309
Name:BERTRAM, JULIA ANNE (LMT)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ANNE
Last Name:BERTRAM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8955 SW 150TH COURT CIR W
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1337
Mailing Address - Country:US
Mailing Address - Phone:305-879-9958
Mailing Address - Fax:
Practice Address - Street 1:40 ISLAND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-1355
Practice Address - Country:US
Practice Address - Phone:305-673-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA84229225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist