Basic Information
| Provider Information | |||||||||
| NPI: | 1407816838 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JENKINS | ||||||||
| FirstName: | JANAE | ||||||||
| MiddleName: | |||||||||
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| Credential: | ATC, CSCS | ||||||||
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| OtherLastName: | LONGORIA | ||||||||
| OtherFirstName: | JANAE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2008 PARKSIDE DR APT 138 | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983104320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604793279 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4060 WHEATON WAY STE C | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983103500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604798477 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2006 | ||||||||
| LastUpdateDate: | 08/21/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.