Provider Demographics
NPI:1518413160
Name:JENKINS, KENNI BOWLING (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KENNI
Middle Name:BOWLING
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 GROVE ROAD, SUITE 2-A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4660
Mailing Address - Country:US
Mailing Address - Phone:864-233-5128
Mailing Address - Fax:864-271-2599
Practice Address - Street 1:2005 EAST GREENVILLE STREET, SUITE 119
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1575
Practice Address - Country:US
Practice Address - Phone:864-964-0505
Practice Address - Fax:864-222-0182
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist