Provider Demographics
NPI:1912968280
Name:JENMARK, LLC
Entity Type:Organization
Organization Name:JENMARK, LLC
Other - Org Name:TECUMSEH PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:405-598-2899
Mailing Address - Street 1:1011 N BROADWAY ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:TECUMSEH
Mailing Address - State:OK
Mailing Address - Zip Code:74873-1431
Mailing Address - Country:US
Mailing Address - Phone:405-598-2899
Mailing Address - Fax:405-598-2833
Practice Address - Street 1:1011 N BROADWAY ST
Practice Address - Street 2:SUITE 6
Practice Address - City:TECUMSEH
Practice Address - State:OK
Practice Address - Zip Code:74873-1431
Practice Address - Country:US
Practice Address - Phone:405-598-2899
Practice Address - Fax:405-598-2833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty