Provider Demographics
NPI:1043293483
Name:JENKINS, RACHELLE (MSPT)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:
Other - Last Name:PARKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:489 WASHINGTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-5709
Mailing Address - Country:US
Mailing Address - Phone:508-721-0000
Mailing Address - Fax:508-721-0100
Practice Address - Street 1:489 WASHINGTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-5709
Practice Address - Country:US
Practice Address - Phone:508-721-0000
Practice Address - Fax:508-721-0100
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17114225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY69536Medicare ID - Type Unspecified