Healthcare Provider Details

I. General information

NPI: 1871256909
Provider Name (Legal Business Name): MA LOURDES JULIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 LUTHER DR
CROWN POINT IN
46307-5054
US

IV. Provider business mailing address

2313 FOLIAGE LN
DYER IN
46311-1978
US

V. Phone/Fax

Practice location:
  • Phone: 219-663-3860
  • Fax:
Mailing address:
  • Phone: 219-333-1402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05003806A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number05003806A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: