Provider Demographics
NPI:1366626681
Name:SCHAFFER, JENNIFER J (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:SCHAFFER
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 1:2615 3 OAKS RD
Mailing Address - Street 2:1A
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-6123
Mailing Address - Country:US
Mailing Address - Phone:847-516-8095
Mailing Address - Fax:847-516-8098
Practice Address - Street 1:2615 THREE OAKS RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-6123
Practice Address - Country:US
Practice Address - Phone:847-516-8095
Practice Address - Fax:847-516-8098
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070005221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist