Provider Demographics
NPI:1801356696
Name:VARTANOV, IULIIA
Entity Type:Individual
Prefix:
First Name:IULIIA
Middle Name:
Last Name:VARTANOV
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 1:8123 SUMMER PALM CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-3951
Mailing Address - Country:US
Mailing Address - Phone:904-624-2531
Mailing Address - Fax:
Practice Address - Street 1:6138 KENNERLY RD UNIT 150
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4395
Practice Address - Country:US
Practice Address - Phone:904-624-2531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant