Provider Demographics
NPI:1083944029
Name:CARPENTER, JENNIFER ANGELINE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANGELINE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:ANGELINE
Other - Last Name:ZIZZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:3703 W LAKE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1223
Mailing Address - Country:US
Mailing Address - Phone:847-998-1188
Mailing Address - Fax:
Practice Address - Street 1:3703 W LAKE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1223
Practice Address - Country:US
Practice Address - Phone:847-998-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160004492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist