MEDICARE: JAMIE A JACKSON MPT

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	018657	PA
2	225100000X	Physical Therapist	070019508	IL

General Provider Information

NPI Number	:	1982812244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE A JACKSON MPT

Provider Business Mailing Address
First Line	:	425 E 50TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-2300
Country	:	US
Telephone Number	:	301-254-1545
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 E 55TH ST STE 305
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-5576
Country	:	US
Telephone Number	:	773-667-8800
Fax Number	:

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

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	02/25/2026

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