Provider Demographics
NPI:1245919018
Name:NIKOLICH, JULIANA GRACE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JULIANA
Middle Name:GRACE
Last Name:NIKOLICH
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 1:400 CENTRAL PARK W APT 1M
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5821
Mailing Address - Country:US
Mailing Address - Phone:847-804-8403
Mailing Address - Fax:
Practice Address - Street 1:53 COLUMBUS AVE STE 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6909
Practice Address - Country:US
Practice Address - Phone:212-541-8450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.027455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist