Provider Demographics
NPI:1124260658
Name:PISCITELLO, JULIE D (PT)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:D
Last Name:PISCITELLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 SANDSTONE RDG
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:KY
Mailing Address - Zip Code:41076-7119
Mailing Address - Country:US
Mailing Address - Phone:859-441-0864
Mailing Address - Fax:
Practice Address - Street 1:828 SANDSTONE RDG
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:KY
Practice Address - Zip Code:41076-7119
Practice Address - Country:US
Practice Address - Phone:847-951-1579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT004933225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100173040Medicaid
KYK019160Medicare PIN
KYP00951597Medicare PIN