Provider Demographics
NPI:1245627447
Name:JENKS, BRETT A (PT, DPT, MDT, CFPS)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:A
Last Name:JENKS
Suffix:
Gender:M
Credentials:PT, DPT, MDT, CFPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 COFFEEN AVE.
Mailing Address - Street 2:STE 101 PMB 286
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-7004
Mailing Address - Country:US
Mailing Address - Phone:307-336-7774
Mailing Address - Fax:
Practice Address - Street 1:1262 W 5TH ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2702
Practice Address - Country:US
Practice Address - Phone:307-336-7774
Practice Address - Fax:307-202-4643
Is Sole Proprietor?:No
Enumeration Date:2015-04-25
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT15522251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1558742981OtherGROUP NPI FOR BACK COUNTRY PHYSICAL THERAPY, LLC