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General NPI Number Information
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NPI Number | 1134158009
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Entity Type | Individual
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Provider Name | GREGORY ALAN JACKSON P.T.
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Gender | Male
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 04/07/2009
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Provider Practice Location Address
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Address Line | 5501 SWIFT RD
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City | SARASOTA
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State | FL
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Zip | 34231-6209
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Country | US
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Telephone | 941-924-7870
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Fax | 941-925-2518
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Provider Business Mailing Address
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Address Line | 6803 46TH TER E
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City | BRADENTON
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State | FL
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Zip | 34203-4251
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Country | US
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Telephone | 941-752-7715
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Fax | 941-925-2518
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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 | PT19566
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License Number State | FL
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