Provider Demographics
NPI:1225528839
Name:FOX, JULIE LYNN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:LYNN
Last Name:FOX
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 CORSAIR CT
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-2134
Mailing Address - Country:US
Mailing Address - Phone:815-717-8037
Mailing Address - Fax:
Practice Address - Street 1:808 CORSAIR CT
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-2134
Practice Address - Country:US
Practice Address - Phone:815-717-8037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160004827225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant