Provider Demographics
NPI:1487924031
Name:CHAN, JULIE YURI (PT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:YURI
Last Name:CHAN
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 1:1200 N WESTMORELAND RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1601
Mailing Address - Country:US
Mailing Address - Phone:847-535-7551
Mailing Address - Fax:
Practice Address - Street 1:10700 MERIDIAN AVE N STE 105
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9008
Practice Address - Country:US
Practice Address - Phone:206-860-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60332634225100000X
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist