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NPI Code Detail

MEDICARE: FREDERICK EARL JENKINS III

MEDICARE: FREDERICK EARL JENKINS III
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
1225100000XPhysical Therapist19608MD

General Provider Information

NPI Number : 1194953729
Entity Type Code : Individual
Provider Name (Legal Business Name) : FREDERICK EARL JENKINS III
Provider Business Mailing Address
First Line : 1881 TELEGRAPH RD
Second Line :
City : RISING SUN
State : MD
Zip : 21911-2018
Country : US
Telephone Number : 410-658-6555
Fax Number :
Provider Business Practice Location Address
First Line : 1881 TELEGRAPH RD
Second Line :
City : RISING SUN
State : MD
Zip : 21911-2018
Country : US
Telephone Number : 410-658-6555
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2009
Last Update Date : 06/22/2009

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