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General NPI Number Information
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NPI Number | 1427448539
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Entity Type | Individual
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Provider Name | LYNDA JETT
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Gender | Female
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Dates
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Enumeration Date | 01/27/2015
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Last Update Date | 01/27/2015
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Provider Practice Location Address
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Address Line | 2216 LESTER DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-2607
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Country | US
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Telephone | 505-296-4808
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Fax |
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Provider Business Mailing Address
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Address Line | 10700 ACADEMY RD NE APT 1517
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-7334
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A-0868
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License Number State | NM
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