Provider Demographics
NPI:1255584371
Name:JUANICH, JEREMY MICHAEL (DPT)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:MICHAEL
Last Name:JUANICH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 KAPALUA DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455
Mailing Address - Country:US
Mailing Address - Phone:805-478-0681
Mailing Address - Fax:
Practice Address - Street 1:3800 RESERVOIR ROAD NW
Practice Address - Street 2:PHYSICAL MEDICINE AND REHABILIATION
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-4180
Practice Address - Fax:202-444-5333
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist