Provider Demographics
NPI:1851546824
Name:FLESNER, JENEL ERIN (PT)
Entity Type:Individual
Prefix:
First Name:JENEL
Middle Name:ERIN
Last Name:FLESNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENEL
Other - Middle Name:ERIN
Other - Last Name:SANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:100 NE RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61606-1919
Mailing Address - Country:US
Mailing Address - Phone:309-624-8575
Mailing Address - Fax:309-624-8566
Practice Address - Street 1:100 NE RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61606-1919
Practice Address - Country:US
Practice Address - Phone:309-624-8575
Practice Address - Fax:309-624-8566
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-013553225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist