Provider Demographics
NPI:1447346325
Name:MCCULLAR, JENNY LYNN (MS, PT)
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:LYNN
Last Name:MCCULLAR
Suffix:
Gender:F
Credentials:MS, PT
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Mailing Address - Street 1:701 COUNTY ROAD 3422
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-7252
Mailing Address - Country:US
Mailing Address - Phone:205-485-7625
Mailing Address - Fax:205-485-2242
Practice Address - Street 1:908 26TH ST
Practice Address - Street 2:
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-1719
Practice Address - Country:US
Practice Address - Phone:205-485-2213
Practice Address - Fax:205-485-2242
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALPTH3646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALQ17287Medicare PIN