Provider Demographics
NPI:1871683698
Name:MATY, JULIE (MS,PT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MATY
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:7225 W COLLEGE DR
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1101
Practice Address - Country:US
Practice Address - Phone:708-361-5355
Practice Address - Fax:708-361-5399
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070006991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619908OtherBCBS OF IL
IL367885100OtherU.S. DEPT. OF LABOR PROV#
IL1623066OtherBCBS PROVIDER #
ILL87615Medicare PIN
IL1623066OtherBCBS PROVIDER #
IL202542Medicare ID - Type UnspecifiedMEDICARE GROUP #
IL367885100OtherU.S. DEPT. OF LABOR PROV#
IL200852Medicare ID - Type UnspecifiedMEDICARE GROUP #
ILR02558Medicare PIN
ILR02557Medicare PIN
ILR02559Medicare PIN
IL567700Medicare PIN