Healthcare Provider Details

I. General information

NPI: 1942299391
Provider Name (Legal Business Name): TIMOTHY MICHAEL JENKINS MS, ATC,PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 01/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

382 W CHESTNUT ST
WASHINGTON PA
15301-4642
US

IV. Provider business mailing address

PO BOX 187
RICHEYVILLE PA
15358-0187
US

V. Phone/Fax

Practice location:
  • Phone: 724-228-2911
  • Fax: 724-228-7339
Mailing address:
  • Phone: 724-632-2095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT001045A
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE008371
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: