Provider Demographics
NPI:1083080865
Name:JENKINS, DANIEL BRIAN (DPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:BRIAN
Last Name:JENKINS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 NW 9TH ST
Mailing Address - Street 2:SUITE180
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6173
Mailing Address - Country:US
Mailing Address - Phone:541-768-5157
Mailing Address - Fax:541-768-5080
Practice Address - Street 1:815 NW 9TH ST
Practice Address - Street 2:SUITE180
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6173
Practice Address - Country:US
Practice Address - Phone:541-768-5157
Practice Address - Fax:541-768-5080
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist