Provider Demographics
NPI:1780224261
Name:MELLNICK, JULIE MARIE (PT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:MELLNICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 ROYAL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4717
Mailing Address - Country:US
Mailing Address - Phone:224-783-6128
Mailing Address - Fax:
Practice Address - Street 1:2320 ROYAL BLVD STE A
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4717
Practice Address - Country:US
Practice Address - Phone:224-783-6128
Practice Address - Fax:224-783-4703
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist