Provider Demographics
NPI:1710319470
Name:JENKINS, MELISSA J (PT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:JENKINS
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 1:710 N 11TH STREET
Mailing Address - Street 2:PO BOX 959
Mailing Address - City:COLUMBUS
Mailing Address - State:MT
Mailing Address - Zip Code:59019-0959
Mailing Address - Country:US
Mailing Address - Phone:406-322-1005
Mailing Address - Fax:406-322-5207
Practice Address - Street 1:710 N 11TH STREET
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MT
Practice Address - Zip Code:59019-0959
Practice Address - Country:US
Practice Address - Phone:406-322-1005
Practice Address - Fax:406-322-5207
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT413032Medicaid
MT271330Medicare Oscar/Certification