Provider Demographics
NPI:1588186902
Name:JENKINS, CALLIE ELISABETH (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CALLIE
Middle Name:ELISABETH
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:ELISABETH
Other - Last Name:LOWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1310 SIDNEY ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7628
Mailing Address - Country:US
Mailing Address - Phone:870-612-7200
Mailing Address - Fax:870-612-7203
Practice Address - Street 1:1310 SIDNEY ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7628
Practice Address - Country:US
Practice Address - Phone:870-612-7200
Practice Address - Fax:870-612-7203
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA4200225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant