Provider Demographics
NPI:1578610499
Name:JENKINS, LYNDA GRAYSON (PT)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:GRAYSON
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:J
Other - Last Name:GRAYSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:245 CAHABA VALLEY PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-2216
Mailing Address - Country:US
Mailing Address - Phone:205-942-6820
Mailing Address - Fax:205-314-7287
Practice Address - Street 1:325 WHISKEY RUN RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AL
Practice Address - Zip Code:36726-2303
Practice Address - Country:US
Practice Address - Phone:334-682-9565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT0816225100000X
ALPTH6363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS650000390Medicare PIN