Provider Demographics
NPI:1841606621
Name:BOLDOSER, JULIANA
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:
Last Name:BOLDOSER
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 1:1414 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1005
Mailing Address - Country:US
Mailing Address - Phone:740-474-9318
Mailing Address - Fax:740-474-9326
Practice Address - Street 1:1414 N COURT ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1005
Practice Address - Country:US
Practice Address - Phone:740-474-9318
Practice Address - Fax:740-474-9326
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA.01711225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant