=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134415482
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE ANN PRATTICO DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2011
-----------------------------------------------------
Last Update Date | 08/13/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 LONG POND RD SUITE 222A
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14626-1177
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-697-0207
-----------------------------------------------------
Fax | 585-697-0209
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6319 FLY RD STE 4
-----------------------------------------------------
City | EAST SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13057-4900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 037537-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------