Healthcare Provider Details

I. General information

NPI: 1245548122
Provider Name (Legal Business Name): ANGELA IRENE JENKINS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 MARKET ST
PARKERSBURG WV
26101-4737
US

IV. Provider business mailing address

1614 LIBERTY ST
PARKERSBURG WV
26101-4128
US

V. Phone/Fax

Practice location:
  • Phone: 304-482-5217
  • Fax: 304-865-5445
Mailing address:
  • Phone: 304-482-5217
  • Fax: 304-865-5445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: