Active NPI
Jenelle Robertson, MPT
- Physical Therapist
- Bonfield, IL
National Provider Identifier
1922514694
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070.017882
- Practice address
- 522 E Smith St
Bonfield, IL 60913-6932 - Phone
- (937) 271-6270
- NPI assigned
- Dec 18, 2017
- Last updated
- Dec 18, 2017
- 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 | 070.017882 | IL | Primary |
Addresses
Primary practice location
522 E Smith St
Bonfield, IL 60913-6932
Mailing address
2252 Valley View Dr
Kankakee, IL 60901-8396
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 070.017882 | Other | IL | DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION |
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 |
|---|---|---|---|
| 070.017882 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1513555200000",
"number": "1922514694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2252 VALLEY VIEW DR",
"city": "KANKAKEE",
"state": "IL",
"postal_code": "609018396"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "522 E SMITH ST",
"city": "BONFIELD",
"state": "IL",
"postal_code": "609136932",
"telephone_number": "937-271-6270"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "JENELLE",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-12-18",
"last_updated": "2017-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070.017882",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION",
"identifier": "070.017882",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bonfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.