Basic Information
Provider Information
NPI: 1912500620
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JULIANO
FirstName: ZACHARY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 475 ALLENDALE RD STE 206
Address2:  
City: KING OF PRUSSIA
State: PA
PostalCode: 194061495
CountryCode: US
TelephoneNumber: 6102700370
FaxNumber:  
Practice Location
Address1: 331 WILMINGTON W CHESTER PIKE
Address2:  
City: GLEN MILLS
State: PA
PostalCode: 193428210
CountryCode: US
TelephoneNumber: 6102700370
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/17/2020
LastUpdateDate: 11/17/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/17/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2251X0800XPT028696PAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic

No ID Information.


Home