Individual
MS. DIANE O JACKSON-SZYMCZYK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2425 LYNBRIDGE DR, CHARLOTTE, NC 28270-7774
(704) 364-4429
Mailing address
2425 LYNBRIDGE DR, CHARLOTTE, NC 28270-7774
(704) 364-4429
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
1260
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7211596
—
NC
Enumeration date
09/15/2008
Last updated
09/15/2008
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