Provider Demographics
NPI:1295312981
Name:GAMBINO, JULIE-ANN
Entity type:Individual
Prefix:
First Name:JULIE-ANN
Middle Name:
Last Name:GAMBINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S FOREST ST APT 118
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1642
Mailing Address - Country:US
Mailing Address - Phone:269-352-8123
Mailing Address - Fax:
Practice Address - Street 1:10313 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2003
Practice Address - Country:US
Practice Address - Phone:720-388-0439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-27
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0024018225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist