Provider Demographics
NPI:1609605013
Name:JENKINS, ALEXIS NICOLE (PTA)
Entity type:Individual
Prefix:MISS
First Name:ALEXIS
Middle Name:NICOLE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4541 N JOSEY LN STE 130
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4662
Mailing Address - Country:US
Mailing Address - Phone:469-212-8888
Mailing Address - Fax:
Practice Address - Street 1:4541 N JOSEY LN STE 130
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4662
Practice Address - Country:US
Practice Address - Phone:469-212-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2184254225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant