Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT11462 | OH |
NPI | 1154529741 |
---|---|
Provider Name | Mrs. Julienne Marie Carlquist |
First Address | Copley, OH 44321-1226 |
Second Address | Fairlawn, OH 44333-3019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2007 |
Last Update Date | 08/07/2007 |