Healthcare Provider Details

I. General information

NPI: 1700854866
Provider Name (Legal Business Name): JENNIFER G FRENZEL P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 BRYANT AVE
GLEN ELLYN IL
60137-4702
US

IV. Provider business mailing address

462 BRYANT AVE
GLEN ELLYN IL
60137-4702
US

V. Phone/Fax

Practice location:
  • Phone: 630-204-2633
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number070-005569
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: