Provider Demographics
NPI:1124080551
Name:BLANDIN, JULIE L (MPT, ATC, CSCS, PRC)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:L
Last Name:BLANDIN
Suffix:
Gender:F
Credentials:MPT, ATC, CSCS, PRC
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:L
Other - Last Name:ANUSZKIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, ATC, CSCS
Mailing Address - Street 1:1340 N GREAT NECK RD
Mailing Address - Street 2:#1272-182
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2268
Mailing Address - Country:US
Mailing Address - Phone:757-416-6700
Mailing Address - Fax:757-416-7777
Practice Address - Street 1:2830 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7614
Practice Address - Country:US
Practice Address - Phone:757-416-6700
Practice Address - Fax:757-416-7777
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204000225100000X
CA38183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7883577OtherAETNA
VA010125511Medicaid
VA192933OtherBCBS PHYSICAL THERAPY
VAP00175699OtherRAILROAD MEDICARE
VA010125511Medicaid
VAC05954Medicare PIN