Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 2305006033 | VA |
NPI | 1255535118 |
---|---|
Provider Name | Gabriel Julian |
First Address | Virginia Beach, VA 23453-8547 |
Second Address | Virginia Beach, VA 23451-1199 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 08/07/2007 |