Healthcare Provider Details

I. General information

NPI: 1093005829
Provider Name (Legal Business Name): JILL LYNES DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL JONES DPT

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 DIXIE HWY STE 130
LOUISVILLE KY
40216-2995
US

IV. Provider business mailing address

734 W MAIN ST STE 106
LOUISVILLE KY
40202-3622
US

V. Phone/Fax

Practice location:
  • Phone: 502-805-3338
  • Fax:
Mailing address:
  • Phone: 502-804-4811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number005764
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1204267
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number037550
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: