Provider Demographics
NPI:1790811867
Name:WHITTAKER, JULIA LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:LYNN
Last Name:WHITTAKER
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 1:1671 KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4258
Mailing Address - Country:US
Mailing Address - Phone:217-440-3824
Mailing Address - Fax:
Practice Address - Street 1:1671 KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4258
Practice Address - Country:US
Practice Address - Phone:217-440-3824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL00132042Medicare UPIN