Provider Demographics
NPI:1942742390
Name:MANCUSO, JULIA MICHAEL (PA-C, MS, ATC)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:MICHAEL
Last Name:MANCUSO
Suffix:
Gender:F
Credentials:PA-C, MS, ATC
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:MICHAEL
Other - Last Name:CARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:2014 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1699
Mailing Address - Country:US
Mailing Address - Phone:617-243-6000
Mailing Address - Fax:
Practice Address - Street 1:2014 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1699
Practice Address - Country:US
Practice Address - Phone:617-243-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2025-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA100359207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty