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General NPI Number Information
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NPI Number | 1801925722
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Entity Type | Individual
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Provider Name | JEANETTE HINCHEY LARK MPT
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Gender | Female
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 25751 PERDIDO BEACH BLVD STE A7
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City | ORANGE BEACH
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State | AL
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Zip | 36561-6237
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Country | US
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Telephone | 251-501-4781
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 CORPORATE DR STE 400
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City | HOOVER
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State | AL
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Zip | 35242-5424
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Country | US
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Telephone | 423-238-7212
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Fax | 232-383-4734
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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 | PTH12080
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT30193
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT-1550
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License Number State | ID
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