MEDICARE: RUSTY L JENKINS PT

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1376723106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSTY L JENKINS PT

Provider Business Mailing Address
First Line	:	2233 ACADEMY PL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1696
Country	:	US
Telephone Number	:	719-475-0808
Fax Number	:	719-475-8822

Provider Business Practice Location Address
First Line	:	2233 ACADEMY PL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1696
Country	:	US
Telephone Number	:	719-475-0808
Fax Number	:	719-475-8822

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

Provider Enumeration Date	:	11/08/2007
Last Update Date	:	11/16/2011

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