Provider Demographics
NPI:1346376183
Name:ALMODOVAR, JULIE LEANORE (PT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LEANORE
Last Name:ALMODOVAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:LEANORE
Other - Last Name:BRUNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:654 W VETERANS PARKWAY
Mailing Address - Street 2:STE D
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-2510
Mailing Address - Country:US
Mailing Address - Phone:630-553-9300
Mailing Address - Fax:630-553-9306
Practice Address - Street 1:654 W VETERANS PARKWAY
Practice Address - Street 2:STE D
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-2510
Practice Address - Country:US
Practice Address - Phone:630-553-9300
Practice Address - Fax:630-553-9306
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.005936225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT33041OtherCALIFORNIA STATE LICENSE
CAPT33041OtherCALIFORNIA STATE LICENSE
CAWPT33041BMedicare PIN