Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT25686 | FL |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 13618 | FL |
NPI | 1093947921 |
---|---|
Provider Name | Sarah Marie Jenkins |
First Address | St Augustine, FL 32085-3123 |
Second Address | St Augustine, FL 32086-5799 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2009 |
Last Update Date | 14/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Z01LJ | BCBS (01) | FL |