Provider Demographics
NPI:1396933750
Name:BOLTZ, JULIET LACARAN (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:JULIET
Middle Name:LACARAN
Last Name:BOLTZ
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 BROAD STREET EXT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-1345
Mailing Address - Country:US
Mailing Address - Phone:860-867-6450
Mailing Address - Fax:860-437-4567
Practice Address - Street 1:728 BROAD STREET EXT
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-1345
Practice Address - Country:US
Practice Address - Phone:860-867-6450
Practice Address - Fax:860-437-4567
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002683172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist