Healthcare Provider Details

I. General information

NPI: 1427448539
Provider Name (Legal Business Name): LYNDA JETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2216 LESTER DR NE
ALBUQUERQUE NM
87112-2607
US

IV. Provider business mailing address

10700 ACADEMY RD NE APT 1517
ALBUQUERQUE NM
87111-7334
US

V. Phone/Fax

Practice location:
  • Phone: 505-296-4808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA-0868
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: