Provider Demographics
NPI:1891043022
Name:HENDRIX, JACQUELYN S (PT)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:S
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:
Other - Last Name:BIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:50 W SCHAUMBURG RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3502
Practice Address - Country:US
Practice Address - Phone:847-490-7100
Practice Address - Fax:847-490-9356
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-019376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist