Provider Demographics
NPI:1386043867
Name:PATE, JENNIFER (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PATE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12172 S IL ROUTE 47 STE 125
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-9619
Mailing Address - Country:US
Mailing Address - Phone:847-920-7110
Mailing Address - Fax:847-920-7110
Practice Address - Street 1:117 S 6TH ST
Practice Address - Street 2:
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118
Practice Address - Country:US
Practice Address - Phone:847-920-7110
Practice Address - Fax:847-920-7110
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist