Provider Demographics
NPI:1720024151
Name:THOMPSON, JENNIFER L (MPT/CHT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MPT/CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:1812 MARSH RD
Practice Address - Street 2:STORE 505
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4581
Practice Address - Country:US
Practice Address - Phone:302-475-7500
Practice Address - Fax:302-894-1601
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10001399225100000X
PAPT012717L225100000X
MD22232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE2116451OtherMAMSI PROVIDER NUMBER
DEP01038120OtherMEDICARE RAILROAD
DE1000037755Medicaid
DE2323901000OtherAMERIHEALTH
DEP01038120OtherMEDICARE RAILROAD
DE1000037755Medicaid
DE2323901000OtherAMERIHEALTH
MD313PQ477Medicare PIN
DE021004A78Medicare PIN