=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023443165
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANEW U PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2013
-----------------------------------------------------
Last Update Date | 01/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2020 HIGHWAY A1A SUITE 109
-----------------------------------------------------
City | INDIAN HARBOUR BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32937-3581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-442-6343
-----------------------------------------------------
Fax | 888-850-4342
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7808 FALLING LEAF PL
-----------------------------------------------------
City | MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32940-6424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-208-2639
-----------------------------------------------------
Fax | 949-861-9668
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/SECRETARY
-----------------------------------------------------
Name | DR. ERIN M JENKINS
-----------------------------------------------------
Credential | DPT, ATC/L
-----------------------------------------------------
Telephone | 949-208-2639
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 39476
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT24251
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------