Provider Demographics
NPI:1558650184
Name:WILKINS, JULIE ELLYN (MPT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ELLYN
Last Name:WILKINS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 DOVER AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-5856
Mailing Address - Country:US
Mailing Address - Phone:773-420-6369
Mailing Address - Fax:
Practice Address - Street 1:58 DOVER AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-5856
Practice Address - Country:US
Practice Address - Phone:773-420-6369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.007633225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist