Healthcare Provider Details

I. General information

NPI: 1609138858
Provider Name (Legal Business Name): JENNIFER LEE LOEFFLER PT, MPT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER LEE HECKROTH PT, MPT

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 W STEPHENSON ST
FREEPORT IL
61032-5005
US

IV. Provider business mailing address

23-24 BROADVIEW DR
LANARK IL
61046-9695
US

V. Phone/Fax

Practice location:
  • Phone: 815-499-0084
  • Fax: 815-417-9288
Mailing address:
  • Phone: 815-499-0084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.013172
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: