Active NPI
Julie Baclene, PT
- Physical Therapist
- San Luis Obispo, CA
National Provider Identifier
1841488715
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 16162
- Practice address
- 805 Aerovista PL
#201
San Luis Obispo, CA 93401-7919 - Phone
- (805) 788-0805
- NPI assigned
- Oct 4, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 16162 | CA | Primary |
Addresses
Primary practice location
805 Aerovista PL
#201
San Luis Obispo, CA 93401-7919
Mailing address
1067 C St
#110
Galt, CA 95632-1757
Phone (209) 745-5802
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16162 | CA | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202256000000",
"number": "1841488715",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1067 C ST",
"address_2": "#110",
"city": "GALT",
"state": "CA",
"postal_code": "956321757",
"telephone_number": "209-745-5802"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "805 AEROVISTA PL",
"address_2": "#201",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934017919",
"telephone_number": "805-788-0805"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACLENE",
"first_name": "JULIE",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-10-04",
"last_updated": "2008-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "16162",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Luis Obispo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.