Provider Demographics
NPI:1306995139
Name:HUNGATE, JENNIFER SERGEANT (PT, DPT, WCS, MS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SERGEANT
Last Name:HUNGATE
Suffix:
Gender:F
Credentials:PT, DPT, WCS, MS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ROSE
Other - Last Name:SERGEANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, WCS, MS
Mailing Address - Street 1:263 N YORK ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2758
Mailing Address - Country:US
Mailing Address - Phone:331-215-4164
Mailing Address - Fax:331-223-9724
Practice Address - Street 1:263 N YORK ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2758
Practice Address - Country:US
Practice Address - Phone:331-215-4164
Practice Address - Fax:331-223-9724
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.013653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist