Provider Demographics
NPI:1932137254
Name:JERKENS, SHIRLEY M (PT)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:M
Last Name:JERKENS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:M
Other - Last Name:COCHRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4515
Mailing Address - Country:US
Mailing Address - Phone:502-314-6584
Mailing Address - Fax:516-216-1905
Practice Address - Street 1:15 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4515
Practice Address - Country:US
Practice Address - Phone:502-314-6584
Practice Address - Fax:516-216-1905
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0312872251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics