Provider Demographics
NPI:1841596012
Name:JENKINS, AMY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:BOZARTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:13101 ELMLEAF CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8801
Mailing Address - Country:US
Mailing Address - Phone:479-263-1446
Mailing Address - Fax:
Practice Address - Street 1:750 SE CARY PKWY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5682
Practice Address - Country:US
Practice Address - Phone:919-651-3964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016724225100000X
NC14053225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist