Healthcare Provider Details

I. General information

NPI: 1770720302
Provider Name (Legal Business Name): JULIE A PEPPER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 FARMINGTON AVE
FARMINGTON CT
06032-1916
US

IV. Provider business mailing address

230 FARMINGTON AVE
FARMINGTON CT
06032-1916
US

V. Phone/Fax

Practice location:
  • Phone: 860-674-1824
  • Fax: 860-674-1836
Mailing address:
  • Phone: 860-674-1824
  • Fax: 860-674-1836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number006614
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: