Provider Demographics
NPI:1942299391
Name:JENKINS, TIMOTHY MICHAEL (MS, ATC,PTA)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MS, ATC,PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:RICHEYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15358-0187
Mailing Address - Country:US
Mailing Address - Phone:724-632-2095
Mailing Address - Fax:
Practice Address - Street 1:382 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4642
Practice Address - Country:US
Practice Address - Phone:724-228-2911
Practice Address - Fax:724-228-7339
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2010-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001045A2255A2300X
PATE008371225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant