Provider Demographics
NPI:1063438703
Name:WATTENBERG- CRAWFORD, JULIE (MPT, DPT)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:WATTENBERG- CRAWFORD
Suffix:
Gender:
Credentials:MPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13909 BRIAR LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-7563
Mailing Address - Country:US
Mailing Address - Phone:690-319-3872
Mailing Address - Fax:815-733-6573
Practice Address - Street 1:13909 BRIAR LN
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-7563
Practice Address - Country:US
Practice Address - Phone:690-319-3872
Practice Address - Fax:815-733-6573
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-0128522251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232772OtherBLUE CROSS BLUE SHIELD