Provider Demographics
NPI:1750139275
Name:JENKINS, MALLORY LYNN (LMT)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:LYNN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3669 PARIS BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4133
Mailing Address - Country:US
Mailing Address - Phone:513-886-3529
Mailing Address - Fax:
Practice Address - Street 1:623 PARK MEADOW RD STE E
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2876
Practice Address - Country:US
Practice Address - Phone:614-619-6965
Practice Address - Fax:614-384-0801
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.011.317225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist