Individual
RANDALL JENKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1982 CHUGWATER DR, CHEYENNE, WY 82009-9354
(307) 286-1957
Mailing address
1982 CHUGWATER DR, CHEYENNE, WY 82009-9354
(307) 286-1957
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
0759
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0759
MEDICARE
WY
Enumeration date
02/18/2013
Last updated
02/18/2013
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