Provider Demographics
NPI:1760505796
Name:JENKINS, STEPHANY LYN (PT)
Entity Type:Individual
Prefix:
First Name:STEPHANY
Middle Name:LYN
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 1:549 E COUNTY LINE RD STE E
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1068
Mailing Address - Country:US
Mailing Address - Phone:317-883-4374
Mailing Address - Fax:317-883-4384
Practice Address - Street 1:549 E COUNTY LINE RD STE E
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1068
Practice Address - Country:US
Practice Address - Phone:317-883-4374
Practice Address - Fax:317-883-4384
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002864A2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics