Provider Demographics
NPI:1841488715
Name:BACLENE, JULIE (PT)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:BACLENE
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 1:1067 C ST
Mailing Address - Street 2:#110
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-1757
Mailing Address - Country:US
Mailing Address - Phone:209-745-5802
Mailing Address - Fax:
Practice Address - Street 1:805 AEROVISTA PL
Practice Address - Street 2:#201
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7919
Practice Address - Country:US
Practice Address - Phone:805-788-0805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT161620Medicare PIN