Provider Demographics
NPI:1053631853
Name:JENKYNS PHYSICAL THERAPY & WELLNESS
Entity Type:Organization
Organization Name:JENKYNS PHYSICAL THERAPY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:JENKYNS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:339-298-2084
Mailing Address - Street 1:800 W CUMMINGS PARK
Mailing Address - Street 2:SUITE 4650
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6372
Mailing Address - Country:US
Mailing Address - Phone:339-298-2084
Mailing Address - Fax:339-298-2085
Practice Address - Street 1:800 W CUMMINGS PARK
Practice Address - Street 2:SUITE 4650
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6372
Practice Address - Country:US
Practice Address - Phone:339-298-2084
Practice Address - Fax:339-298-2085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4829225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY65468Medicare PIN