Provider Demographics
NPI:1659610848
Name:LALIK, JULIANNE
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:LALIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIANNE
Other - Middle Name:
Other - Last Name:CARRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5350 ALLISON DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-3460
Mailing Address - Country:US
Mailing Address - Phone:248-496-6754
Mailing Address - Fax:
Practice Address - Street 1:18285 E 10 MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-5802
Practice Address - Country:US
Practice Address - Phone:586-774-5774
Practice Address - Fax:586-774-5884
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist