Provider Demographics
NPI:1124377221
Name:SCHRANCK, JACQUELINE D (DPT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:D
Last Name:SCHRANCK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:D
Other - Last Name:SPIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:600 OAKMONT LN
Mailing Address - Street 2:STE 600C
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:2937 S BRENTWOOD BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-2713
Practice Address - Country:US
Practice Address - Phone:314-961-3804
Practice Address - Fax:314-961-1147
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.019678225100000X
MO2012027769225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO991509014Medicare PIN
MO991511010Medicare PIN