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NPI Code Detail

MEDICARE: MS. MAIESHA N'TASHA JACKSON

MEDICARE: MS. MAIESHA N'TASHA 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
1225100000XPhysical Therapist
2225100000XPhysical Therapist3170NV

General Provider Information

NPI Number : 1831523356
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MAIESHA N'TASHA JACKSON
Provider Business Mailing Address
First Line : 10785 W TWAIN AVE STE 250
Second Line :
City : LAS VEGAS
State : NV
Zip : 89135-3026
Country : US
Telephone Number : 725-726-7847
Fax Number :
Provider Business Practice Location Address
First Line : 4000 S EASTERN AVE STE 150
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-0840
Country : US
Telephone Number : 725-726-7847
Fax Number : 725-726-7876
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2013
Last Update Date : 09/17/2024

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Directions to “ MS. MAIESHA N'TASHA JACKSON ” Practice Location

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