Provider Demographics
NPI:1205099652
Name:THIBOS, JULIE A (MPT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:THIBOS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 LILY CACHE LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-4600
Mailing Address - Country:US
Mailing Address - Phone:630-226-5110
Mailing Address - Fax:
Practice Address - Street 1:1337 LILY CACHE LN
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-4600
Practice Address - Country:US
Practice Address - Phone:630-226-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216859034Medicare PIN
IL212623012Medicare PIN
IL212989013Medicare PIN
202845020Medicare PIN
IL214708018Medicare PIN
IL216860017Medicare PIN
IL211585019Medicare PIN
IL212608010Medicare PIN
IL205782017Medicare PIN
IL206974009Medicare PIN
IL211082014Medicare PIN
IL214692017Medicare PIN
IL212622013Medicare PIN