Provider Demographics
NPI:1093045940
Name:REZABEK, JENNIFER K (MPT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:K
Last Name:REZABEK
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:K
Other - Last Name:SCHLICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:15 APEX DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-1282
Mailing Address - Country:US
Mailing Address - Phone:618-441-0482
Mailing Address - Fax:618-441-0482
Practice Address - Street 1:134 CHESTERFIELD VALLEY DRIVE
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1161
Practice Address - Country:US
Practice Address - Phone:636-812-0094
Practice Address - Fax:636-812-0152
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009037275225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO150900045Medicare PIN