Jenna M Fulks, PT, DPT

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

070.026739 Issued in IL

Practice address

997 N Corporate Cir Ste B
Grayslake, IL 60030-7822

Phone

(847) 223-8001

Fax

(847) 986-3580

NPI assigned

Jul 28, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Grayslake Rehabilitation and Complete Physical Therapy LLCGroup PAC ID 4183679400, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grayslake Rehabilitation and Complete Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Grayslake, IL
  • NPI 1982726683

  Orthopedic

  Medicare reassignment Care Compare group NPD
• Caitlin Chandran MSN, Aprn-Fpa, FNP-BC PLLC

  • Primary Care Clinic/Center
  • Grayslake, IL
  • NPI 1316661036
  NPD

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

{
    "created_epoch": "1658966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658966400000",
    "number": "1124754593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "997 N CORPORATE CIR STE B",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600307822",
            "telephone_number": "847-223-8001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "997 N CORPORATE CIR STE B",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600307822",
            "telephone_number": "847-223-8001",
            "fax_number": "847-986-3580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULKS",
        "first_name": "JENNA",
        "middle_name": "M",
        "name_prefix": "Miss",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-28",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "IL",
            "license": "070.026739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.grayslakerehab.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "997 N Corporate Cir Ste B",
            "city": "Grayslake",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600307822",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jenifer Marie Frechette, MSW
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• Cassidy Jordyn Friedman, M.A. CCC-SLP
• Lindsey Frystak, BA
• Fukari Psych, PLLC
• Functional Performance Chiropractic, LTD
• G G Family Dental Care PC
• John N Gaetano, M.D.
• Edward J Galarza Jr., BS PT
• Diana Gallardo

• Orthopedic Physical Therapist in Grayslake, IL
• Providers in Grayslake, IL by specialty
• Orthopedic Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.