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General NPI Number Information
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NPI Number | 1972732816
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Entity Type | Individual
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Provider Name | LYNDSAY MARIE JACKSON DPT
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Gender | Female
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Dates
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Enumeration Date | 07/14/2009
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 1200 J D ANDERSON DR
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City | MORGANTOWN
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State | WV
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Zip | 26505-3494
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Country | US
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Telephone | 304-598-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 320 JONES AVE
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City | BRIDGEPORT
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State | WV
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Zip | 26330-1414
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Country | US
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Telephone | 301-268-2427
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2758
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License Number State | WV
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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 | PT2758
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License Number State | WV
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