Provider Demographics
NPI:1326163742
Name:JENKERSON, TERRILL WARREN (PT)
Entity Type:Individual
Prefix:MR
First Name:TERRILL
Middle Name:WARREN
Last Name:JENKERSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4332 BREMNER DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-3642
Mailing Address - Country:US
Mailing Address - Phone:512-706-5002
Mailing Address - Fax:512-459-3911
Practice Address - Street 1:4332 BREMNER DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-3642
Practice Address - Country:US
Practice Address - Phone:512-706-5002
Practice Address - Fax:512-459-3911
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1047405225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F6906Medicare PIN