Provider Demographics
NPI:1881079234
Name:RENTNER, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RENTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 FOXFIELD DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-5343
Mailing Address - Country:US
Mailing Address - Phone:630-553-7737
Mailing Address - Fax:630-553-7747
Practice Address - Street 1:129 COMMERCIAL DR
Practice Address - Street 2:UNIT 5A
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-4729
Practice Address - Country:US
Practice Address - Phone:630-553-7737
Practice Address - Fax:630-553-7747
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.006709225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL227006709OtherSTATE LICENSE