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General NPI Number Information
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NPI Number | 1114330610
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Entity Type | Individual
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Provider Name | ERICA JACKSON DPT
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Gender | Female
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Dates
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Enumeration Date | 06/03/2014
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Last Update Date | 08/13/2021
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Provider Practice Location Address
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Address Line | 7989 BELT LINE RD STE 90
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City | DALLAS
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State | TX
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Zip | 75248-5728
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Country | US
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Telephone | 972-942-2475
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Fax | 972-645-0687
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Provider Business Mailing Address
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Address Line | 2122 YORK RD STE 300
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City | OAK BROOK
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State | IL
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Zip | 60523-1925
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Country | US
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Telephone | 630-575-6200
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Fax | 630-575-7450
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1243858
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License Number State | TX
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