Healthcare Provider Details

I. General information

NPI: 1700085636
Provider Name (Legal Business Name): JENNIFER MARY TAYLOR P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12531 REGENCY PKWY
HUNTLEY IL
60142-6500
US

IV. Provider business mailing address

12531 REGENCY PKWY
HUNTLEY IL
60142-6500
US

V. Phone/Fax

Practice location:
  • Phone: 847-659-1000
  • Fax: 847-659-1012
Mailing address:
  • Phone: 847-659-1000
  • Fax: 847-659-1012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number070003332
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: