Individual
JENNIFER M FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
21 US HIGWAY 41, SCHERERVILLE, IN 46375
(219) 803-3880
Mailing address
600 OAKMONT LN STE 600C, WESTMONT, IL 60559-5548
(630) 575-6200
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05010965A
IN
225100000X
Physical Therapist
070012582
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619908
BCBS IL GROUP NUMBER
IL
01
—
1623066
BCBS PROVIDER NUMBER
IL
01
—
367885100
US DEPT OF LABOR
IL
Enumeration date
07/12/2006
Last updated
05/21/2018
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