Healthcare Provider Details

I. General information

NPI: 1609355445
Provider Name (Legal Business Name): JENNIFER MARIE WILLIAMS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

486 RANDALL RD UNIT B
SOUTH ELGIN IL
60177-3354
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 224-783-6128
  • Fax: 224-783-2131
Mailing address:
  • Phone: 847-390-5900
  • Fax: 847-390-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number05013099A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.024711
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: