Healthcare Provider Details

I. General information

NPI: 1659204691
Provider Name (Legal Business Name): JENNIFER QUINTAS MAT, LAT, ATC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 W MAIN ST
BARRINGTON IL
60010-3015
US

IV. Provider business mailing address

2411 CUSTER AVE
ROCKFORD IL
61103-4326
US

V. Phone/Fax

Practice location:
  • Phone: 847-842-3263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: