Provider Demographics
NPI:1457831406
Name:JAKSZTA, LINDSAY (DPT)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:JAKSZTA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9802 MITCHELL GLEN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6605
Mailing Address - Country:US
Mailing Address - Phone:817-456-6738
Mailing Address - Fax:
Practice Address - Street 1:857 PROMENADE WALK
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6992
Practice Address - Country:US
Practice Address - Phone:803-547-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC112212251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic