Provider Demographics
NPI:1770941023
Name:JULIANA PHYSICIAL THERAPY LLC
Entity type:Organization
Organization Name:JULIANA PHYSICIAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-334-9580
Mailing Address - Street 1:14765 MICHIGAN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3455
Mailing Address - Country:US
Mailing Address - Phone:313-406-9094
Mailing Address - Fax:
Practice Address - Street 1:14765 MICHIGAN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3455
Practice Address - Country:US
Practice Address - Phone:313-406-9094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicare PIN