Healthcare Provider Details

I. General information

NPI: 1033022132
Provider Name (Legal Business Name): LYDIA JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 RIDGEWAY LN
MILLINGTON TN
38053-8917
US

IV. Provider business mailing address

107 RIDGEWAY LN
MILLINGTON TN
38053-8917
US

V. Phone/Fax

Practice location:
  • Phone: 901-413-3373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16066
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: