Basic Information
| Provider Information | |||||||||
| NPI: | 1801219753 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | JENKINS | ||||||||
| FirstName: | JAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1103 ANCHOR STREET | ||||||||
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| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18124 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1780 KENDARBREN DR | ||||||||
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| City: | JAMISON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189291064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154898760 | ||||||||
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| ProviderEnumerationDate: | 01/29/2014 | ||||||||
| LastUpdateDate: | 01/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist |
No ID Information.