Provider Demographics
NPI:1275570525
Name:JENKINS, RUTH
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1772
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-7772
Mailing Address - Country:US
Mailing Address - Phone:850-682-7772
Mailing Address - Fax:850-682-1539
Practice Address - Street 1:728 N FERDON BLVD
Practice Address - Street 2:STE #3
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-2166
Practice Address - Country:US
Practice Address - Phone:850-682-7772
Practice Address - Fax:888-308-1539
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20009225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL410160000Medicaid
FLY04XXOtherBCBS
FLY8094OtherBCBS FLORIDA
FLY8094OtherBCBS FLORIDA