Provider Demographics
NPI:1942360854
Name:JENKINS, JUDITH DALE (PT)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:DALE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10500 WHISPERING PINE LN
Mailing Address - Street 2:
Mailing Address - City:MC GAHEYSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22840-2386
Mailing Address - Country:US
Mailing Address - Phone:540-289-7977
Mailing Address - Fax:
Practice Address - Street 1:235 CANTRELL AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3248
Practice Address - Country:US
Practice Address - Phone:540-564-5799
Practice Address - Fax:540-564-7042
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist