MEDICARE: JULIA BRUNEAU PT

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	2305204352	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	181573	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1568423382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA BRUNEAU PT

Provider Business Mailing Address
First Line	:	504 ALBEMARLE SQ
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-7405
Country	:	US
Telephone Number	:	434-817-7848
Fax Number	:	434-465-6834

Provider Business Practice Location Address
First Line	:	416 ALBEMARLE SQ
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-7400
Country	:	US
Telephone Number	:	434-443-0295
Fax Number	:	434-465-6843

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	12/06/2023

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