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General NPI Number Information
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NPI Number | 1225941917
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Entity Type | Individual
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Provider Name | JULIE DEMENTYEVA PTA
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Gender | Female
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Dates
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Enumeration Date | 09/24/2026
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Last Update Date | 09/24/2026
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Provider Practice Location Address
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Address Line | 326 E 149TH ST BLDG SUITE
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City | BRONX
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State | NY
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Zip | 10451-5602
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Country | US
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Telephone | 718-928-6582
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Fax |
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Provider Business Mailing Address
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Address Line | 620 W 143RD ST APT 6H
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City | NEW YORK
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State | NY
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Zip | 10031-5954
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Country | US
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Telephone | 951-566-6750
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 015414
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License Number State | NY
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