Provider Demographics
NPI:1841869963
Name:HAINES, JULIA THERESE (DPT)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:THERESE
Last Name:HAINES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:THERESE
Other - Last Name:SHANKLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:610 S MAPLE AVE STE 3500
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-2801
Mailing Address - Country:US
Mailing Address - Phone:708-934-7062
Mailing Address - Fax:708-934-7065
Practice Address - Street 1:610 S MAPLE AVE STE 3500
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-2801
Practice Address - Country:US
Practice Address - Phone:708-934-7062
Practice Address - Fax:708-934-7065
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.025911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist