MEDICARE: DR. BRADLEY PAUL JENKINS 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	OH-8844	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629035233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY PAUL JENKINS DPT

Provider Business Mailing Address
First Line	:	PO BOX 378
Second Line	:
City	:	SANDUSKY
State	:	OH
Zip	:	44871-0378
Country	:	US
Telephone Number	:	419-626-6161
Fax Number	:	419-502-3511

Provider Business Practice Location Address
First Line	:	1430 SOM CENTER RD STE 1
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-2123
Country	:	US
Telephone Number	:	440-442-7111
Fax Number	:	440-460-1767

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	05/01/2020

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