MEDICARE: ERICA BOSWELL JACKSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	P24279	NC

General Provider Information

NPI Number	:	1043198849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA BOSWELL JACKSON

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:	570-550-0168
Fax Number	:

Provider Business Practice Location Address
First Line	:	166 SPRINGBROOK AVE STE 201
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27520-8520
Country	:	US
Telephone Number	:	919-535-8461
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2025
Last Update Date	:	02/13/2026

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Directions to “ ERICA BOSWELL JACKSON ” Practice Location

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