Active NPI
Diane O Jackson-Szymczyk, PT
- Pediatric Physical Therapist
- Charlotte, NC
National Provider Identifier
1437308483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 1260
- Practice address
- 2425 Lynbridge Dr
Charlotte, NC 28270-7774 - Phone
- (704) 364-4429
- NPI assigned
- Sep 15, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 1260 | NC | Primary |
Addresses
Primary practice location
2425 Lynbridge Dr
Charlotte, NC 28270-7774
Mailing address
2425 Lynbridge Dr
Charlotte, NC 28270-7774
Phone (704) 364-4429
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7211596 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1260 | NC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221436800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221436800000",
"number": "1437308483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2425 LYNBRIDGE DR",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282707774",
"telephone_number": "704-364-4429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2425 LYNBRIDGE DR",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282707774",
"telephone_number": "704-364-4429"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON-SZYMCZYK",
"first_name": "DIANE",
"middle_name": "O",
"name_prefix": "Ms.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-09-15",
"last_updated": "2008-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "NC",
"license": "1260",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7211596",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.