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General NPI Number Information
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NPI Number | 1205067592
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Entity Type | Individual
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Provider Name | JENNIFER L ANTHONY PT
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Gender | Female
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Dates
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Enumeration Date | 08/04/2009
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Last Update Date | 04/21/2022
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Provider Practice Location Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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Country | US
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Telephone | 412-394-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 208 DOUD DR
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City | NORMAL
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State | IL
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Zip | 61761-3212
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Country | US
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Telephone | 614-266-6948
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT009566
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.024920
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License Number State | IL
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