Provider Demographics
NPI:1730668690
Name:HENRIQUEZ-GIL, JULENNE
Entity Type:Individual
Prefix:
First Name:JULENNE
Middle Name:
Last Name:HENRIQUEZ-GIL
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 1:202 W IRELAND RD STE 101A
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-2516
Mailing Address - Country:US
Mailing Address - Phone:574-404-5069
Mailing Address - Fax:574-309-9878
Practice Address - Street 1:202 W IRELAND RD STE 101A
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614
Practice Address - Country:US
Practice Address - Phone:574-404-5069
Practice Address - Fax:574-309-9878
Is Sole Proprietor?:No
Enumeration Date:2018-08-11
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist