Provider Demographics
NPI:1063537728
Name:COSENZA, JULIE ANN (LMT)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:COSENZA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11321 SW 158TH ST
Mailing Address - Street 2:
Mailing Address - City:ARCHER
Mailing Address - State:FL
Mailing Address - Zip Code:32618-3941
Mailing Address - Country:US
Mailing Address - Phone:352-495-7646
Mailing Address - Fax:352-495-7646
Practice Address - Street 1:1411 NW 6TH ST
Practice Address - Street 2:UNIT 120
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4021
Practice Address - Country:US
Practice Address - Phone:352-870-2381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA15043225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC7068OtherBCBS PROVIDER ID