Basic Information
| Provider Information | |||||||||
| NPI: | 1578610499 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JENKINS | ||||||||
| FirstName: | LYNDA | ||||||||
| MiddleName: | GRAYSON | ||||||||
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| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | GRAYSON | ||||||||
| OtherFirstName: | LYNDA | ||||||||
| OtherMiddleName: | J | ||||||||
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| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 245 CAHABA VALLEY PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PELHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351242216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059426820 | ||||||||
| FaxNumber: | 2053147287 | ||||||||
| Practice Location | |||||||||
| Address1: | 325 WHISKEY RUN RD | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 367262303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3346829565 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 07/25/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT0816 | MS | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PTH6363 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.