Jennifer Lynne Smith, PTA, ATC, NCMT

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

160-007698 Issued in IL

Practice address

1310 N Main St Ste 100
Sandwich, IL 60548-1394

Phone

(815) 786-6000

Fax

(815) 786-3603

NPI assigned

Oct 9, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1223510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1104077015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1952 ABERDEEN CT",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783175",
            "telephone_number": "815-758-0000",
            "fax_number": "815-748-3014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 N MAIN ST STE 100",
            "city": "SANDWICH",
            "state": "IL",
            "postal_code": "605481394",
            "telephone_number": "815-786-6000",
            "fax_number": "815-786-3603"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2111 Midlands Ct",
            "address_purpose": "LOCATION",
            "city": "Sycamore",
            "state": "IL",
            "postal_code": "601783125",
            "country_code": "US",
            "telephone_number": "815-758-0000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JENNIFER",
        "middle_name": "LYNNE",
        "name_prefix": "Mrs.",
        "credential": "PTA, ATC, NCMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-10-09",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160-007698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Seja Limited
• Silver Wings Senior Transport LLC
• Miricle Simonson
• Skan LLC
• William R Skutta, O.D.
• Lindsey Nicole Fae Smith, LCSW
• Penelope Spiekerman, DDS
• Maria Dana Sutkus, DO
• Jahangir Tai, D.O.
• Shawn Michael Tessmer, BA, MA, LCPC

• Physical Therapy Assistant in Sandwich, IL
• Providers in Sandwich, IL by specialty
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.