Provider Demographics
NPI:1841771714
Name:WALCH, JULIANNA KLOSSON (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:JULIANNA
Middle Name:KLOSSON
Last Name:WALCH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PIPER RD
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7575
Mailing Address - Country:US
Mailing Address - Phone:207-510-5224
Mailing Address - Fax:207-883-7120
Practice Address - Street 1:15 PIPER RD
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7575
Practice Address - Country:US
Practice Address - Phone:207-510-5224
Practice Address - Fax:207-883-7120
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist