MEDICARE: JENNIFER A. DRENNAN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070021471	IL

General Provider Information

NPI Number	:	1316408776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER A. DRENNAN DPT

Provider Business Mailing Address
First Line	:	1025 S 6TH ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62703-2499
Country	:	US
Telephone Number	:	217-528-7541
Fax Number	:

Provider Business Practice Location Address
First Line	:	1259 LAKE PLAZA DR STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3542
Country	:	US
Telephone Number	:	719-632-7669
Fax Number	:	719-632-0088

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2019
Last Update Date	:	07/03/2023

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