MEDICARE: DR. MYAU GEANINE JENKINS PT, DPT, MOT R/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist		NV
2	261QP2000X	Physical Therapy Clinic/Center		NV

General Provider Information

NPI Number	:	1194224378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MYAU GEANINE JENKINS PT, DPT, MOT R/L

Provider Business Mailing Address
First Line	:	6355 BLUE TWILIGHT CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-6447
Country	:	US
Telephone Number	:	702-904-0629
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 N DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1220
Country	:	US
Telephone Number	:	702-813-9827
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2018
Last Update Date	:	02/02/2018

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