MEDICARE: MRS. NOREEN VICTORIA ZULAICA P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT006193	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346232949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NOREEN VICTORIA ZULAICA P.T.

Provider Business Mailing Address
First Line	:	2089 TERON TRCE
Second Line	:	SUITE 120
City	:	DACULA
State	:	GA
Zip	:	30019-1662
Country	:	US
Telephone Number	:	770-904-6009
Fax Number	:	770-904-2357

Provider Business Practice Location Address
First Line	:	2089 TERON TRCE
Second Line	:	SUITE 120
City	:	DACULA
State	:	GA
Zip	:	30019-1662
Country	:	US
Telephone Number	:	770-904-6009
Fax Number	:	770-904-2357

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	03/12/2018

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