Provider Demographics
NPI:1821497207
Name:BARBOLYUK, VIOLETA
Entity Type:Individual
Prefix:MISS
First Name:VIOLETA
Middle Name:
Last Name:BARBOLYUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5358 N CUMBERLAND AVE
Mailing Address - Street 2:APT 507
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-1412
Mailing Address - Country:US
Mailing Address - Phone:773-997-0519
Mailing Address - Fax:
Practice Address - Street 1:2745 MAPLE AVE
Practice Address - Street 2:2D
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3280
Practice Address - Country:US
Practice Address - Phone:630-778-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227011556225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist