Healthcare Provider Details

I. General information

NPI: 1063479574
Provider Name (Legal Business Name): JENNIFER NAVE LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 W EVERGREEN AVE
EFFINGHAM IL
62401-1619
US

IV. Provider business mailing address

7092 E CLARKSVILLE RD
MARTINSVILLE IL
62442-2003
US

V. Phone/Fax

Practice location:
  • Phone: 217-342-3400
  • Fax: 217-342-9714
Mailing address:
  • Phone: 217-967-5263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: