Provider Demographics
NPI:1720221427
Name:JAYLYNN REYNOLDS-FARR PT LLC
Entity Type:Organization
Organization Name:JAYLYNN REYNOLDS-FARR PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAYLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS-FARR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:706-736-0221
Mailing Address - Street 1:262 WIRE RD
Mailing Address - Street 2:
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-7981
Mailing Address - Country:US
Mailing Address - Phone:706-595-1490
Mailing Address - Fax:706-595-6070
Practice Address - Street 1:3604 VERANDAH DR
Practice Address - Street 2:SUITE E
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-5608
Practice Address - Country:US
Practice Address - Phone:706-736-0221
Practice Address - Fax:706-736-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT005495261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy