Provider Demographics
NPI:1346232949
Name:ZULAICA, NOREEN VICTORIA (PT)
Entity type:Individual
Prefix:MRS
First Name:NOREEN
Middle Name:VICTORIA
Last Name:ZULAICA
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 1:2089 TERON TRCE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-1662
Mailing Address - Country:US
Mailing Address - Phone:770-904-6009
Mailing Address - Fax:770-904-2357
Practice Address - Street 1:2089 TERON TRCE
Practice Address - Street 2:SUITE 120
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1662
Practice Address - Country:US
Practice Address - Phone:770-904-6009
Practice Address - Fax:770-904-2357
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000856171BMedicaid