Provider Demographics
NPI:1649042508
Name:DA SILVA, JULIANA OURIQUE (PT)
Entity type:Individual
Prefix:MRS
First Name:JULIANA
Middle Name:OURIQUE
Last Name:DA SILVA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 LA TRAVESIA FLORA UNIT 204
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-4827
Mailing Address - Country:US
Mailing Address - Phone:561-726-9670
Mailing Address - Fax:
Practice Address - Street 1:465 TOWN PLAZA AVE STE B
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32081-5190
Practice Address - Country:US
Practice Address - Phone:904-222-3780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT40260225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist