Provider Demographics
NPI:1386797975
Name:LICONG, JULIUSCAESAR ORIAS (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:JULIUSCAESAR
Middle Name:ORIAS
Last Name:LICONG
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
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Mailing Address - Street 1:3105 INNOVATION DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST. CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769
Mailing Address - Country:US
Mailing Address - Phone:407-498-0539
Mailing Address - Fax:877-203-2038
Practice Address - Street 1:3105 INNOVATION DRIVE
Practice Address - Street 2:
Practice Address - City:ST. CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769
Practice Address - Country:US
Practice Address - Phone:407-498-0539
Practice Address - Fax:877-203-2038
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2010-11-11
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist