Provider Demographics
NPI:1508076571
Name:DRUIEN, JENIFER ELIZABETH (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:ELIZABETH
Last Name:DRUIEN
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 1:6756 N SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:IL
Mailing Address - Zip Code:61010-9381
Mailing Address - Country:US
Mailing Address - Phone:815-742-5369
Mailing Address - Fax:
Practice Address - Street 1:811 W 2ND ST
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:IL
Practice Address - Zip Code:61010-1464
Practice Address - Country:US
Practice Address - Phone:815-234-5898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.009494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist