Provider Demographics
NPI:1609343326
Name:BATTEIGER, JACLYN ALYSSA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:ALYSSA
Last Name:BATTEIGER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 SOUTHPARK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4209
Mailing Address - Country:US
Mailing Address - Phone:904-824-1478
Mailing Address - Fax:
Practice Address - Street 1:190 SOUTHPARK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4209
Practice Address - Country:US
Practice Address - Phone:904-824-1478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0015980225100000X
FLPT33829225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist