Provider Demographics
NPI:1972792653
Name:ABREU, JULISSA M
Entity type:Individual
Prefix:
First Name:JULISSA
Middle Name:M
Last Name:ABREU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULISSA
Other - Middle Name:A
Other - Last Name:BAKARDJIEV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2623 S SEACREST BLVD LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7501
Mailing Address - Country:US
Mailing Address - Phone:561-737-7733
Mailing Address - Fax:
Practice Address - Street 1:2623 S SEACREST BLVD LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7501
Practice Address - Country:US
Practice Address - Phone:561-737-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT136542251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics