Provider Demographics
NPI:1811256951
Name:GENOCHIO, JULIANNE R (MPT)
Entity type:Individual
Prefix:
First Name:JULIANNE
Middle Name:R
Last Name:GENOCHIO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JULIANNE
Other - Middle Name:R
Other - Last Name:BISHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3497
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-0300
Mailing Address - Country:US
Mailing Address - Phone:888-201-1040
Mailing Address - Fax:866-245-8064
Practice Address - Street 1:2313 N BELTLINE BLVD
Practice Address - Street 2:SUITE C/D
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-3416
Practice Address - Country:US
Practice Address - Phone:803-787-2623
Practice Address - Fax:866-245-8064
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q394408915Medicare PIN