Provider Demographics
NPI:1194776443
Name:HALLQUIST, JENNIFER (PT, DPT, LMT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HALLQUIST
Suffix:
Gender:F
Credentials:PT, DPT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 W BELL RD
Mailing Address - Street 2:SUITE F-101
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8529
Mailing Address - Country:US
Mailing Address - Phone:623-776-9111
Mailing Address - Fax:623-776-9115
Practice Address - Street 1:7200 W BELL RD
Practice Address - Street 2:SUITE F-101
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8529
Practice Address - Country:US
Practice Address - Phone:623-776-9111
Practice Address - Fax:623-776-9115
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist