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NPI Code Detail

MEDICARE: MRS. JULIENNE MARIE CARLQUIST DPT

MEDICARE: MRS. JULIENNE MARIE CARLQUIST DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251G0304XGeriatric Physical TherapistPT11462OH

General Provider Information

NPI Number : 1154529741
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JULIENNE MARIE CARLQUIST DPT
Provider Business Mailing Address
First Line : 4546 PINEWOOD PATH
Second Line :
City : COPLEY
State : OH
Zip : 44321-1226
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 575 S CLEVELAND MASSILLON RD
Second Line :
City : FAIRLAWN
State : OH
Zip : 44333-3019
Country : US
Telephone Number : 330-666-5866
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2007
Last Update Date : 07/08/2007

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