Provider Demographics
NPI:1710212501
Name:WIECH, JULIE MARIE (NCTMB, MMP)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:MARIE
Last Name:WIECH
Suffix:
Gender:F
Credentials:NCTMB, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 W CHAPMAN AVE
Mailing Address - Street 2:SUITE 272
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2647
Mailing Address - Country:US
Mailing Address - Phone:714-771-1827
Mailing Address - Fax:
Practice Address - Street 1:2050 W CHAPMAN AVE
Practice Address - Street 2:SUITE 272
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2647
Practice Address - Country:US
Practice Address - Phone:714-771-1827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIN PROCESS225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist