Healthcare Provider Details

I. General information

NPI: 1740491679
Provider Name (Legal Business Name): JENKERSON PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W 38TH ST SUITE 10
AUSTIN TX
78731-6321
US

IV. Provider business mailing address

1500 W 38TH ST SUITE 10
AUSTIN TX
78731-6321
US

V. Phone/Fax

Practice location:
  • Phone: 512-459-3900
  • Fax: 512-459-3911
Mailing address:
  • Phone: 512-459-3900
  • Fax: 512-459-3911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1047405
License Number StateTX

VIII. Authorized Official

Name: MR. TERRILL W. JENKERSON
Title or Position: OWNER
Credential: PT
Phone: 512-459-3900