Provider Demographics
NPI:1912915950
Name:HALAMA, Y JUSTINE (PT)
Entity Type:Individual
Prefix:
First Name:Y
Middle Name:JUSTINE
Last Name:HALAMA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 MILLET ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2754
Mailing Address - Country:US
Mailing Address - Phone:847-302-8983
Mailing Address - Fax:630-801-9497
Practice Address - Street 1:1220 MILLET ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2754
Practice Address - Country:US
Practice Address - Phone:847-302-8983
Practice Address - Fax:630-801-9497
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012570225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist