Provider Demographics
NPI:1851608277
Name:JENKINS, JAMES HAROLD (LPTA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HAROLD
Last Name:JENKINS
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 CROWNE CLUB DR
Mailing Address - Street 2:APARTMENT 13
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-3590
Mailing Address - Country:US
Mailing Address - Phone:336-403-7545
Mailing Address - Fax:
Practice Address - Street 1:215 CROWNE CLUB DR
Practice Address - Street 2:APARTMENT 13
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-3590
Practice Address - Country:US
Practice Address - Phone:336-403-7545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC202225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant