Provider Demographics
NPI:1194224378
Name:JENKINS, MYAU GEANINE (PT, DPT, MOT R/L)
Entity Type:Individual
Prefix:DR
First Name:MYAU
Middle Name:GEANINE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PT, DPT, MOT R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 BLUE TWILIGHT CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-6447
Mailing Address - Country:US
Mailing Address - Phone:702-904-0629
Mailing Address - Fax:
Practice Address - Street 1:1101 N DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-1220
Practice Address - Country:US
Practice Address - Phone:702-813-9827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV225X00000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist