Provider Demographics
NPI:1447500814
Name:DELISLE, JENA LYNN (DPT)
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:LYNN
Last Name:DELISLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:LYNN
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:3601 30TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1695
Practice Address - Country:US
Practice Address - Phone:262-657-7071
Practice Address - Fax:262-657-0632
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT-27753225100000X
WI12150-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT-27753OtherPHYSICAL THERAPIST LICENSE NUMBER