Basic Information
| Provider Information | |||||||||
| NPI: | 1871256909 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JULIANOTOPACIO | ||||||||
| FirstName: | MALOURDES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2313 FOLIAGE LN | ||||||||
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| City: | DYER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463111978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193331402 | ||||||||
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| Practice Location | |||||||||
| Address1: | 353 TYLER ST | ||||||||
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| City: | GARY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464021149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198867070 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2021 | ||||||||
| LastUpdateDate: | 10/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251G0304X | 05003806A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics |
No ID Information.