MEDICARE: BRANDON JACKSON PT

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	2251S0007X	Sports Physical Therapist	1365	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205266764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANDON JACKSON PT

Provider Business Mailing Address
First Line	:	4765 S DURANGO DR
Second Line	:	SUITE 106
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8145
Country	:	US
Telephone Number	:	702-898-7633
Fax Number	:	702-898-6433

Provider Business Practice Location Address
First Line	:	4765 S DURANGO DR
Second Line	:	SUITE 106
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8145
Country	:	US
Telephone Number	:	702-898-7633
Fax Number	:	702-898-6433

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	BRANDON L JACKSON
Credential	:	P.T.
Telephone Number	:	702-845-1386

Provider Enumeration Date	:	11/20/2013
Last Update Date	:	05/02/2014

Similar Medicare Providers

1497734503 — REBECCA L PRIVITT PT
Practice Location Address:

4765 S DURANGO DR , SUITE #106
LAS VEGAS, NV
89147-8145

Practice Phone: 702-898-7633
Practice Fax: 927-881-9519

1730121419 — BRIDGET ANN HOLDAR MS PT
Practice Location Address:

4765 S DURANGO DR , SUITE #106
LAS VEGAS, NV
89147-8145

Practice Phone: 702-898-7633
Practice Fax:

1821114695 — DR. WILLIAM G. ROBISON D.D.S.
Practice Location Address:

4765 S DURANGO DR , SUITE #100
LAS VEGAS, NV
89147-8145

Practice Phone: 702-384-5070
Practice Fax: 702-247-1894

1164715652 — BRANDON K RICHARDS PT
Practice Location Address:

4765 S DURANGO DR , 106
LAS VEGAS, NV
89147-8145

Practice Phone: 702-898-7633
Practice Fax: 702-898-6433

1013962604 — HARLAN KENNETH KOPOLOW O.D.
Practice Location Address:

8145 W SAHARA AVE , SUITE 510
LAS VEGAS, NV
89117-1994

Practice Phone: 702-733-6764
Practice Fax: 702-255-5795

1659472777 — PEARLE VISION INC
Practice Location Address:

8145 W SAHARA AVE , STE 510
LAS VEGAS, NV
89117-1994

Practice Phone: 702-869-1744
Practice Fax:

Directions to “BRANDON JACKSON PT ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.