Basic Information
| Provider Information | |||||||||
| NPI: | 1871040279 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | JENKS | ||||||||
| FirstName: | JOSHUA | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8644 SUDLEY RD STE 308 | ||||||||
| Address2: | |||||||||
| City: | MANASSAS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201104425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5712929910 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1076 W CHANDLER BLVD | ||||||||
| Address2: | 103 | ||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852245225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808211997 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2016 | ||||||||
| LastUpdateDate: | 07/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 12491 | AZ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 2305212458 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.