Provider Demographics
NPI:1922541077
Name:GLICK, JULIA (DPT)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:GLICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2129
Mailing Address - Country:US
Mailing Address - Phone:773-770-2419
Mailing Address - Fax:773-248-5732
Practice Address - Street 1:1320 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2129
Practice Address - Country:US
Practice Address - Phone:773-770-2419
Practice Address - Fax:773-248-5732
Is Sole Proprietor?:No
Enumeration Date:2016-11-22
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070022426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist