Provider Demographics
NPI:1134415482
Name:PRATTICO, JULIE ANN (DPT)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:PRATTICO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:PASKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6319 FLY RD STE 4
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-4900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 LONG POND RD
Practice Address - Street 2:SUITE 222A
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-1177
Practice Address - Country:US
Practice Address - Phone:585-697-0207
Practice Address - Fax:585-697-0209
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037537-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD196518200Medicaid
DC6357OtherCARE FIRST OF NCA
MDS936SOOtherCARE FIRST OF MARYLAND