Provider Demographics
NPI:1316632482
Name:DENWOOD, JAMIE LYN (PTA)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LYN
Last Name:DENWOOD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10591 PALACE CT
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-9317
Mailing Address - Country:US
Mailing Address - Phone:779-475-1063
Mailing Address - Fax:
Practice Address - Street 1:1752 WINDSOR RD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4280
Practice Address - Country:US
Practice Address - Phone:815-977-3747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160008350225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant