Healthcare Provider Details

I. General information

NPI: 1245627447
Provider Name (Legal Business Name): BRETT A JENKS PT, DPT, MDT, CFPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2015
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1262 W 5TH ST
SHERIDAN WY
82801-2702
US

IV. Provider business mailing address

51 COFFEEN AVE. STE 101 PMB 286
SHERIDAN WY
82801-7004
US

V. Phone/Fax

Practice location:
  • Phone: 307-336-7774
  • Fax: 307-202-4643
Mailing address:
  • Phone: 307-336-7774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT1552
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1552
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: