Provider Demographics
NPI:1013366467
Name:FAHEY, JENNESA (DPT)
Entity Type:Individual
Prefix:
First Name:JENNESA
Middle Name:
Last Name:FAHEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNESA
Other - Middle Name:
Other - Last Name:KINSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:16139 WEBER RD
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-8742
Practice Address - Country:US
Practice Address - Phone:815-836-3403
Practice Address - Fax:815-836-3404
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.022630225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist