Provider Demographics
NPI:1548323413
Name:JENKINS, HEATHER (PT, DPT, ATP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PT, DPT, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4521 HAMPTONRIDGE DR
Mailing Address - Street 2:APT. 202
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4319
Mailing Address - Country:US
Mailing Address - Phone:704-321-4574
Mailing Address - Fax:
Practice Address - Street 1:4405 SARDIS CHURCH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-7998
Practice Address - Country:US
Practice Address - Phone:704-575-2670
Practice Address - Fax:704-553-7587
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC870575225100000X
NC11226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist