Healthcare Provider Details

I. General information

NPI: 1013242866
Provider Name (Legal Business Name): JULIE M CICALIS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 10/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EAST BRIDGEWATER PHYSICAL THERAPY ONE COMPASS WAY SUITE 204
EAST BRIDGEWATER MA
02333
UM

IV. Provider business mailing address

HINGHAM PHYSICAL THERAPY, INC. 350 LINCOLN STREET SUITE 104
HINGHAM MA
02043
UM

V. Phone/Fax

Practice location:
  • Phone: 508-350-2920
  • Fax: 508-350-2317
Mailing address:
  • Phone: 781-740-4900
  • Fax: 781-740-4930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6066
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: