Provider Demographics
NPI:1104877562
Name:WEST, JULIE (PT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:WEST
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 1:38 S MAIN ST
Mailing Address - Street 2:SUITE A & B
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-5031
Mailing Address - Country:US
Mailing Address - Phone:630-466-5866
Mailing Address - Fax:630-466-5869
Practice Address - Street 1:38 S MAIN ST
Practice Address - Street 2:SUITE A & B
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-5031
Practice Address - Country:US
Practice Address - Phone:630-466-5866
Practice Address - Fax:630-466-5869
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070005680208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation