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General NPI Number Information
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NPI Number | 1841247418
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY OF JACKSON PC.
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2782 N HIGHLAND AVE SUITE A
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City | JACKSON
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State | TN
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Zip | 38305-1798
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Country | US
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Telephone | 731-664-1172
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Fax | 731-664-3139
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Provider Business Mailing Address
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Address Line | 2782 N HIGHLAND AVE SUITE A
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City | JACKSON
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State | TN
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Zip | 38305-1798
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Country | US
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Telephone | 731-664-1172
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Fax | 731-664-3139
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ALEXANDER LUY
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Credential | PT, MBA
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Telephone | 731-664-1172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 261QP2000X
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License Number State | TN
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