Provider Demographics
NPI:1275609315
Name:JENKYNS, PATRICIA JOANNE (PT)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JOANNE
Last Name:JENKYNS
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 1:121 REED ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1706
Mailing Address - Country:US
Mailing Address - Phone:617-354-2050
Mailing Address - Fax:617-441-2620
Practice Address - Street 1:800 W CUMMINGS PARK
Practice Address - Street 2:SUITE 4650
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6372
Practice Address - Country:US
Practice Address - Phone:339-298-2084
Practice Address - Fax:339-298-2085
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4829225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY65468Medicare ID - Type Unspecified