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NPI Code Detail

MEDICARE: JULIE L BAILOR PT

MEDICARE: JULIE L BAILOR PT
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
1225100000XPhysical Therapist070013449IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1070013449OTHERILLICENSE

General Provider Information

NPI Number : 1962709766
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE L BAILOR PT
Provider Business Mailing Address
First Line : PO BOX 2176
Second Line : DEPT 5389
City : MILWAUKEE
State : WI
Zip : 53201-2176
Country : US
Telephone Number : 815-713-2600
Fax Number : 815-654-8020
Provider Business Practice Location Address
First Line : 3475 S ALPINE RD
Second Line :
City : ROCKFORD
State : IL
Zip : 61109-2604
Country : US
Telephone Number : 815-874-8000
Fax Number : 815-874-7525
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2011
Last Update Date : 02/15/2011

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