Healthcare Provider Details

I. General information

NPI: 1225869233
Provider Name (Legal Business Name): JULIA MARIE CLEARY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 CONGRESS ST
PORTLAND ME
04101-3308
US

IV. Provider business mailing address

91 WEBBER HILL RD
KENNEBUNK ME
04043-6317
US

V. Phone/Fax

Practice location:
  • Phone: 207-536-4968
  • Fax:
Mailing address:
  • Phone: 207-615-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT6916
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: