Provider Demographics
NPI:1093866741
Name:JENKINS, KAROLYN (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:KAROLYN
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:GREENPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11944-1514
Mailing Address - Country:US
Mailing Address - Phone:631-219-3168
Mailing Address - Fax:
Practice Address - Street 1:152 E MARKET ST STE 200
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-2160
Practice Address - Country:US
Practice Address - Phone:717-242-4840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019441-1225100000X
PAPT028148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00274337Medicaid
NY00274337Medicaid