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General NPI Number Information
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NPI Number | 1457651499
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Entity Type | Individual
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Provider Name | JEFFREY M JENKUSKY PT, RN
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Gender | Male
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Dates
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Enumeration Date | 10/25/2010
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Last Update Date | 01/05/2018
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Provider Practice Location Address
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Address Line | 100 SUMMIT HILLS DR
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City | SPARTANBURG
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State | SC
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Zip | 29307-1532
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Country | US
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Telephone | 864-354-7132
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Fax |
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Provider Business Mailing Address
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Address Line | 750 E ADAMS ST
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City | SYRACUSE
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State | NY
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Zip | 13210-2342
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Country | US
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Telephone | 315-464-2300
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Fax | 315-464-2305
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 8786
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 012768-1
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License Number State | NY
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