Provider Demographics
NPI:1912097106
Name:THOMPSON, JENELLE JOHNS (DPT, SCS, ATC)
Entity Type:Individual
Prefix:MRS
First Name:JENELLE
Middle Name:JOHNS
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DPT, SCS, ATC
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 1:799 E HAMPDEN AVE
Practice Address - Street 2:STE 303
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2700
Practice Address - Country:US
Practice Address - Phone:303-565-1380
Practice Address - Fax:303-565-1385
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0009595225100000X
GA8854261QP2000X
TN1044261QP2000X
CO9595261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist