Provider Demographics
NPI:1366994915
Name:KUMAR, JULIANNE (PTA, MT)
Entity type:Individual
Prefix:MRS
First Name:JULIANNE
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:PTA, MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4435 GILLOT BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33981-1719
Mailing Address - Country:US
Mailing Address - Phone:941-830-0893
Mailing Address - Fax:
Practice Address - Street 1:4166 TAMIAMI TRAIL, UNIT A
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952
Practice Address - Country:US
Practice Address - Phone:941-766-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA20696208100000X
FLMA83575225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist