Provider Demographics
NPI:1740491679
Name:JENKERSON PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:JENKERSON PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRILL
Authorized Official - Middle Name:W
Authorized Official - Last Name:JENKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:512-459-3900
Mailing Address - Street 1:1500 W 38TH ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6321
Mailing Address - Country:US
Mailing Address - Phone:512-459-3900
Mailing Address - Fax:512-459-3911
Practice Address - Street 1:1500 W 38TH ST
Practice Address - Street 2:SUITE 10
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6321
Practice Address - Country:US
Practice Address - Phone:512-459-3900
Practice Address - Fax:512-459-3911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1047405261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y488Medicare PIN