Provider Demographics
NPI:1730131186
Name:VINCENT, JULIANNE
Entity Type:Individual
Prefix:MS
First Name:JULIANNE
Middle Name:
Last Name:VINCENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10921 STONEY POINT DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-9296
Mailing Address - Country:US
Mailing Address - Phone:248-345-5796
Mailing Address - Fax:
Practice Address - Street 1:7743 GRAND RIVER RD
Practice Address - Street 2:#100
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7393
Practice Address - Country:US
Practice Address - Phone:810-227-3588
Practice Address - Fax:810-227-4993
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002145225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist