MEDICARE: DR. KALEIGH IRIS JENKINS PT, DPT, LAT, ATC

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	P24753	NC
2	2255A2300X	Athletic Trainer	LAT-5197	NC

General Provider Information

NPI Number	:	1619508181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KALEIGH IRIS JENKINS PT, DPT, LAT, ATC

Provider Business Mailing Address
First Line	:	105 JOHNSBURY DR
Second Line	:
City	:	STANLEY
State	:	NC
Zip	:	28164-1594
Country	:	US
Telephone Number	:	704-842-2102
Fax Number	:

Provider Business Practice Location Address
First Line	:	1533 S MAIN ST
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-2738
Country	:	US
Telephone Number	:	336-770-3288
Fax Number	:

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

Provider Enumeration Date	:	02/03/2020
Last Update Date	:	03/06/2026

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