Provider Demographics
NPI:1639132921
Name:BAFIA, JULIE A (ATC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:BAFIA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23W121 KINGS CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-7215
Mailing Address - Country:US
Mailing Address - Phone:773-412-9208
Mailing Address - Fax:
Practice Address - Street 1:2035 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3935
Practice Address - Country:US
Practice Address - Phone:773-528-7502
Practice Address - Fax:773-528-7702
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer