Provider Demographics
NPI:1851726632
Name:LARSON, JULIANNE NOEL YAHOLKOVSKY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JULIANNE
Middle Name:NOEL YAHOLKOVSKY
Last Name:LARSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4157 N CLARENDON AVE
Mailing Address - Street 2:APT 701
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2268
Mailing Address - Country:US
Mailing Address - Phone:425-208-6276
Mailing Address - Fax:
Practice Address - Street 1:4157 N CLARENDON AVE
Practice Address - Street 2:APT 701
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2268
Practice Address - Country:US
Practice Address - Phone:425-208-6276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020251225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist