MEDICARE: MS. JULIE DIANNE DE LUNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	160003215	IL

General Provider Information

NPI Number	:	1013613827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIE DIANNE DE LUNA

Provider Business Mailing Address
First Line	:	2244 121ST PL
Second Line	:
City	:	BLUE ISLAND
State	:	IL
Zip	:	60406-1335
Country	:	US
Telephone Number	:	708-351-6473
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 TORRENCE AVE STE 900
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-5430
Country	:	US
Telephone Number	:	708-915-3190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2023
Last Update Date	:	02/02/2023

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