1346376183 NPI number — JULIE LEANORE ALMODOVAR P.T.

Table of content: JULIE LEANORE ALMODOVAR P.T. (NPI 1346376183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346376183 NPI number — JULIE LEANORE ALMODOVAR P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALMODOVAR
Provider First Name:
JULIE
Provider Middle Name:
LEANORE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRUNS
Provider Other First Name:
JULIE
Provider Other Middle Name:
LEANORE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346376183
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
654 W VETERANS PARKWAY
Provider Second Line Business Mailing Address:
STE D
Provider Business Mailing Address City Name:
YORKVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60560-2510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-553-9300
Provider Business Mailing Address Fax Number:
630-553-9306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
654 W VETERANS PARKWAY
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
YORKVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60560-2510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-553-9300
Provider Business Practice Location Address Fax Number:
630-553-9306
Provider Enumeration Date:
02/26/2007

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:  070.005936 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PT33041 . This is a "CALIFORNIA STATE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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