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General NPI Number Information
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NPI Number | 1366304941
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Entity Type | Individual
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Provider Name | REESE JENKINS
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Gender | Male
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 2135 S FREMONT AVE
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City | SPRINGFIELD
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State | MO
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Zip | 65804-2239
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Country | US
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Telephone | 417-820-2160
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Fax |
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Provider Business Mailing Address
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Address Line | 4467 N SHIRLEY AVE
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City | SPRINGFIELD
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State | MO
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Zip | 65803-4551
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Country | US
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Telephone | 417-413-6830
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 2024033383
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License Number State | MO
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