Provider Demographics
NPI:1548582372
Name:DIPERT, JULIE MEREDETH (DPT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MEREDETH
Last Name:DIPERT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MEREDETH
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:5000 ROCKSIDE RD
Mailing Address - Street 2:STE 500
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2178
Mailing Address - Country:US
Mailing Address - Phone:216-459-2846
Mailing Address - Fax:216-901-2803
Practice Address - Street 1:435 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2221
Practice Address - Country:US
Practice Address - Phone:216-749-6650
Practice Address - Fax:330-723-8920
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-21
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT014596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH12077852OtherCAQH
OH0211984Medicaid