Provider Demographics
NPI:1649528639
Name:JENKINS, LISA GAYE (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:GAYE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E. 10TH STREET
Mailing Address - Street 2:REGIONAL MEDICAL CENTER
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-4716
Mailing Address - Country:US
Mailing Address - Phone:256-235-5236
Mailing Address - Fax:256-235-5590
Practice Address - Street 1:731 LEIGHTON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5761
Practice Address - Country:US
Practice Address - Phone:256-235-5236
Practice Address - Fax:256-235-5590
Is Sole Proprietor?:No
Enumeration Date:2012-08-22
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH5984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist