Provider Demographics
NPI:1336241397
Name:HUGHES, JULIE BLOOM (PT, DPT, CERT MDT)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:BLOOM
Last Name:HUGHES
Suffix:
Gender:F
Credentials:PT, DPT, CERT MDT
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:LOUISE
Other - Last Name:BLOOM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:110 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2507
Mailing Address - Country:US
Mailing Address - Phone:315-668-5230
Mailing Address - Fax:315-668-5232
Practice Address - Street 1:110 W 6TH ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2507
Practice Address - Country:US
Practice Address - Phone:315-668-5230
Practice Address - Fax:315-668-5232
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030872-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1093Medicare PIN