Healthcare Provider Details

I. General information

NPI: 1619587524
Provider Name (Legal Business Name): JULIA NICOLE DWYER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIA FABIANO

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 COMMUNITY DR
GREAT NECK NY
11021-5502
US

IV. Provider business mailing address

3567 PARK AVE
WANTAGH NY
11793-3705
US

V. Phone/Fax

Practice location:
  • Phone: 516-719-3745
  • Fax:
Mailing address:
  • Phone: 516-280-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: