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General NPI Number Information
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NPI Number | 1528680931
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Entity Type | Individual
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Provider Name | JULIE LYN BROCKMAN LMT
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Gender | Female
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Dates
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Enumeration Date | 05/08/2020
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Last Update Date | 05/08/2020
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Provider Practice Location Address
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Address Line | 29W585 BATAVIA RD STE 4
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City | WARRENVILLE
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State | IL
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Zip | 60555-1952
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Country | US
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Telephone | 630-927-9867
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Fax |
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Provider Business Mailing Address
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Address Line | 18372 W SPRINGWOOD DR
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City | GRAYSLAKE
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State | IL
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Zip | 60030-4014
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Country | US
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Telephone | 630-776-6156
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 227005071
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License Number State | IL
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