Provider Demographics
NPI:1861156150
Name:RICARDO, JULIA MARIE (ATS)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:MARIE
Last Name:RICARDO
Suffix:
Gender:F
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GAIL DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06472-1307
Mailing Address - Country:US
Mailing Address - Phone:475-238-5809
Mailing Address - Fax:
Practice Address - Street 1:6 GAIL DR
Practice Address - Street 2:
Practice Address - City:NORTHFORD
Practice Address - State:CT
Practice Address - Zip Code:06472-1307
Practice Address - Country:US
Practice Address - Phone:475-238-5809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-24
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2255A2300X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer