Provider Demographics
NPI:1356381156
Name:REIMOLD, JULIANNA THERESA (PT)
Entity type:Individual
Prefix:MRS
First Name:JULIANNA
Middle Name:THERESA
Last Name:REIMOLD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JULIANNA
Other - Middle Name:THERESA
Other - Last Name:DINSMORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1377 MOTOR PKWY
Mailing Address - Street 2:STE 307
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-580-5222
Practice Address - Street 1:500 CHASE PKWY
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3346
Practice Address - Country:US
Practice Address - Phone:203-754-2266
Practice Address - Fax:203-591-8680
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003988225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004265769Medicaid
CT004265769Medicaid