Healthcare Provider Details

I. General information

NPI: 1366304941
Provider Name (Legal Business Name): REESE JENKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 S FREMONT AVE
SPRINGFIELD MO
65804-2239
US

IV. Provider business mailing address

4467 N SHIRLEY AVE
SPRINGFIELD MO
65803-4551
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-2160
  • Fax:
Mailing address:
  • Phone: 417-413-6830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2024033383
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: