Provider Demographics
NPI:1225269806
Name:JENKINS-BROWN, BONNIE LYNN (PT)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:LYNN
Last Name:JENKINS-BROWN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 WATERFORD ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-9385
Mailing Address - Country:US
Mailing Address - Phone:386-409-9208
Mailing Address - Fax:386-424-9204
Practice Address - Street 1:2011 WATERFORD ESTATES DR
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-9385
Practice Address - Country:US
Practice Address - Phone:386-409-9208
Practice Address - Fax:386-424-9204
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 15291225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist