MEDICARE: JENNIFER BRENCZEWSKI 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
1	225100000X	Physical Therapist	070-014965	IL

General Provider Information

NPI Number	:	1114972932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER BRENCZEWSKI PT

Provider Business Mailing Address
First Line	:	900 RAND RD
Second Line	:	SUITE 300
City	:	DES PLAINES
State	:	IL
Zip	:	60016-2359
Country	:	US
Telephone Number	:	847-324-3976
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 N MICHIGAN AVE
Second Line	:	SUITE 1400
City	:	CHICAGO
State	:	IL
Zip	:	60601-7553
Country	:	US
Telephone Number	:	312-251-4511
Fax Number	:

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	11/16/2015

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