Provider Demographics
NPI:1760461636
Name:FLAHERTY, JULIE L (PT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:L
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 NEPONSET ST FL ST2
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-856-9510
Mailing Address - Fax:508-853-1907
Practice Address - Street 1:50 GOLD STAR BLVD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606
Practice Address - Country:US
Practice Address - Phone:508-856-9510
Practice Address - Fax:508-853-1907
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0318868Medicaid
Y67950OtherBLUE CARE ELECT
Y68490OtherMEDICARE B
0318868OtherMEDICAID WELFARE
2779432001OtherCIGNA PAL ID (REFERRAL #)
35481155OtherCIGNA HEALTHSOURCE
42398OtherFALLON COMM. HEALTH PLAN
042472266OtherHEALTHCARE VALUE MANAGEME
AA4052OtherHARVARD PILGRIM HEALTHCAR
2779432OtherCIGNA HEALTH PLAN
785953OtherMVP HEALTH CARE
Y67950OtherBLUE SHIELD INDEMNITY
7873621OtherAETNA US HEALTHCARE
042472266OtherONE HEALTH PLAN
042472266OtherPRIVATE HEALTHCARE SYSTEM
650017682OtherRAILROAD MEDICARE
Y67950OtherBLUE SHIELD HMO BLUE
35481155OtherCIGNA HEALTHSOURCE
MAY68490Medicare ID - Type Unspecified