Basic Information
| Provider Information | |||||||||
| NPI: | 1194953729 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JENKINS | ||||||||
| FirstName: | FREDERICK | ||||||||
| MiddleName: | EARL | ||||||||
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| NameSuffix: | III | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1881 TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | RISING SUN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219112018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106586555 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1881 TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | RISING SUN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219112018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106586555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2009 | ||||||||
| LastUpdateDate: | 06/22/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 19608 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.