Provider Demographics
NPI:1669174108
Name:CLEVELAND, JULIE ADELE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ADELE
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ADELE
Other - Last Name:KAUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6612 MEADOW LAKE DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-4824
Mailing Address - Country:US
Mailing Address - Phone:505-306-5696
Mailing Address - Fax:
Practice Address - Street 1:6612 MEADOW LAKE DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-4824
Practice Address - Country:US
Practice Address - Phone:505-306-5696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist