MEDICARE: LINDSEY JACKMAN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501304159	MI

General Provider Information

NPI Number	:	1144193483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY JACKMAN DPT

Provider Business Mailing Address
First Line	:	64 SHOTWELL ST
Second Line	:
City	:	WHITE LAKE
State	:	MI
Zip	:	48386-2462
Country	:	US
Telephone Number	:	248-635-1158
Fax Number	:

Provider Business Practice Location Address
First Line	:	5225 HIGHLAND RD
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48327-1916
Country	:	US
Telephone Number	:	248-673-6980
Fax Number	:	248-673-7497

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2025
Last Update Date	:	10/24/2025

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