Provider Demographics
NPI:1891094348
Name:ZARAGOZA, JENESSA NOWAK (DPT)
Entity Type:Individual
Prefix:
First Name:JENESSA
Middle Name:NOWAK
Last Name:ZARAGOZA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 S FRONTAGE RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5830
Mailing Address - Country:US
Mailing Address - Phone:630-920-4670
Mailing Address - Fax:630-920-4689
Practice Address - Street 1:1255 S STATE ST
Practice Address - Street 2:UNIT 6
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1928
Practice Address - Country:US
Practice Address - Phone:312-880-0808
Practice Address - Fax:312-880-0810
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016710225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist