Provider Demographics
NPI:1073625604
Name:JENKINS, JAMES ELISHA (PHD, PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ELISHA
Last Name:JENKINS
Suffix:
Gender:M
Credentials:PHD, PT
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:ELIJAH
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, PT
Mailing Address - Street 1:11761 TRENTON RD
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:OH
Mailing Address - Zip Code:43021-9511
Mailing Address - Country:US
Mailing Address - Phone:740-971-8344
Mailing Address - Fax:740-971-8344
Practice Address - Street 1:12 TROY RD
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-4502
Practice Address - Country:US
Practice Address - Phone:740-513-4853
Practice Address - Fax:740-513-2334
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0070332251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2759680Medicaid
OH2759680Medicaid