Individual
MISS JENNIFER ELIZABETH GUILLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT, ATC/L, CSCS
Contact information
Practice address
12800 MISSIPPI PARKWAY, SUITE A101, CROWN POINT, IN 46307
(219) 662-5778
Mailing address
8759 CLARK PL, CROWN POINT, IN 46307-1649
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
05011192A
IN
2255A2300X
Athletic Trainer
36002055A
IN
Other
Enumeration date
09/18/2013
Last updated
09/18/2013
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