Active NPI
Jessica Jenkins
- Physical Therapy Clinic/Center
- Lake City, FL
National Provider Identifier
1295371045
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Clinic/Center
- License
- PTA22075
- Practice address
- 945 SW Main Blvd
Lake City, FL 32025-5746 - Phone
- (386) 755-3164
- NPI assigned
- Nov 26, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | PTA22075 | FL | Primary |
Addresses
Primary practice location
945 SW Main Blvd
Lake City, FL 32025-5746
Mailing address
945 SW Main Blvd
Lake City, FL 32025-5746
Phone (386) 755-3164
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA22075 | FL | MD | Physical Therapy Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1574726400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574726400000",
"number": "1295371045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "945 SW MAIN BLVD",
"city": "LAKE CITY",
"state": "FL",
"postal_code": "320255746",
"telephone_number": "386-755-3164"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "945 SW MAIN BLVD",
"city": "LAKE CITY",
"state": "FL",
"postal_code": "320255746",
"telephone_number": "386-755-3164"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENKINS",
"first_name": "JESSICA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-11-26",
"last_updated": "2019-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": "FL",
"license": "PTA22075",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.