Active NPI
Jennifer Lea Williams, PT
- Physical Therapist
- Crystal Lake, IL
National Provider Identifier
1093825192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070010221
- Practice address
- 5814 Shadowood Drive
Crystal Lake, IL 60012 - Phone
- (224) 622-5801
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070010221 | IL | Primary |
Addresses
Primary practice location
5814 Shadowood Drive
Crystal Lake, IL 60012
Mailing address
5814 Shadowood Drive
Crystal Lake, IL 60012
Phone (224) 622-5801
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5632125 | Other | IL | BCBS NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070010221 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1093825192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5814 SHADOWOOD DRIVE",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "60012",
"telephone_number": "224-622-5801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5814 SHADOWOOD DRIVE",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "60012",
"telephone_number": "224-622-5801"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "JENNIFER",
"middle_name": "LEA",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070010221",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS NUMBER",
"identifier": "5632125",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Crystal Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.