Provider Demographics
NPI:1235114695
Name:ROSSI, JENNIFER L (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:ROSSI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:10262 SAWMILL PKWY
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-9189
Practice Address - Country:US
Practice Address - Phone:614-791-0700
Practice Address - Fax:614-791-0702
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-05429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP86983Medicare UPIN
OHRO4104841Medicare ID - Type Unspecified