1215552419 NPI number — JULIE E VOLLBRECHT DPT

Table of content: JULIE E VOLLBRECHT DPT (NPI 1215552419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215552419 NPI number — JULIE E VOLLBRECHT DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VOLLBRECHT
Provider First Name:
JULIE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAAKE
Provider Other First Name:
JULIE
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1215552419
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
790 REMINGTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOLINGBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60440-4909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-370-8206
Provider Business Mailing Address Fax Number:
517-435-3670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28535 E. DUPONT HIGHWAY
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
MILLSBORO
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-297-0700
Provider Business Practice Location Address Fax Number:
302-297-0701
Provider Enumeration Date:
06/12/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  4272 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PT-2023-2278 . This is a "LICENSE-PT" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com