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General NPI Number Information
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NPI Number | 1437112679
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Entity Type | Individual
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Provider Name | JENNIFER RACKLEY PT
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Gender | Female
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1903 S HAWTHORNE RD DBA EDWIN H. MARTINAT REHABILITATION CENTER
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City | WINSTON SALEM
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State | NC
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Zip | 27103-3916
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Country | US
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Telephone | 336-718-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 FRONTIS PLAZA BLVD STE 200 (ATTN) FORSYTH MEDICAL GROUP
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City | WINSTON SALEM
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State | NC
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Zip | 27103-5616
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Country | US
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Telephone | 336-277-2435
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Fax | 336-277-9275
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 8518
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License Number State | NC
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