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General NPI Number Information
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NPI Number | 1790806982
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Entity Type | Individual
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Provider Name | JENNIFER MARIE SHIN PTA
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Gender | Female
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 7131 N MELVINA AVE
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City | CHICAGO
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State | IL
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Zip | 60646-1123
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Country | US
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Telephone | 937-838-9319
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Fax |
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Provider Business Mailing Address
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Address Line | 7131 N MELVINA AVE
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City | CHICAGO
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State | IL
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Zip | 60646-1123
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Country | US
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Telephone | 937-838-9319
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 05420
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160004420
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License Number State | IL
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