Healthcare Provider Details

I. General information

NPI: 1215900253
Provider Name (Legal Business Name): PATRICK SEAN JENKINS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOX 354070 GRAVES BLDG UNIVERSITY OF WASHINGTON TRAINING ROOM
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

1128 24TH AVE
SEATTLE WA
98122-4858
US

V. Phone/Fax

Practice location:
  • Phone: 206-685-8419
  • Fax: 206-685-3521
Mailing address:
  • Phone: 206-669-4115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: