Healthcare Provider Details

I. General information

NPI: 1932295375
Provider Name (Legal Business Name): SHEILA J. JACKSON R.K.T., C.D.R.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N GREENE ST
BALTIMORE MD
21201-1524
US

IV. Provider business mailing address

13505 WINDING TRAIL CT
SILVER SPRING MD
20906-5830
US

V. Phone/Fax

Practice location:
  • Phone: 410-605-7000
  • Fax: 410-605-7680
Mailing address:
  • Phone: 301-603-0255
  • Fax: 410-605-7680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number1332
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: