MEDICARE: DR. DREW THOMAS JENK DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	62-028287	NY
2	225100000X	Physical Therapist	LPT-013099	AZ

General Provider Information

NPI Number	:	1164692117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DREW THOMAS JENK DPT

Provider Business Mailing Address
First Line	:	4045 E BELL RD STE 150
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2239
Country	:	US
Telephone Number	:	602-992-8352
Fax Number	:

Provider Business Practice Location Address
First Line	:	4045 E BELL RD STE 150
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2239
Country	:	US
Telephone Number	:	602-992-8352
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2008
Last Update Date	:	01/10/2020

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