Provider Demographics
NPI:1740264126
Name:FAIRMAN, JULIE (PT, CWT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:FAIRMAN
Suffix:
Gender:F
Credentials:PT, CWT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 LIGONIER ST
Mailing Address - Street 2:SUITE 001
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1805
Mailing Address - Country:US
Mailing Address - Phone:724-537-9577
Mailing Address - Fax:724-537-0195
Practice Address - Street 1:1176 MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-4514
Practice Address - Country:US
Practice Address - Phone:724-357-9991
Practice Address - Fax:724-357-9993
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist