Provider Demographics
NPI:1881862787
Name:LANN, JULIETTE SUSAN (RPT AND LMT)
Entity Type:Individual
Prefix:
First Name:JULIETTE
Middle Name:SUSAN
Last Name:LANN
Suffix:
Gender:F
Credentials:RPT AND LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15472 SW 148TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-4621
Mailing Address - Country:US
Mailing Address - Phone:786-412-4147
Mailing Address - Fax:
Practice Address - Street 1:14000 NW 1ST AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-4851
Practice Address - Country:US
Practice Address - Phone:305-681-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT5630225100000X
FLMA30407225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist