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General NPI Number Information
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NPI Number | 1154716934
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Entity Type | Individual
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Provider Name | AARON JACKSON DO, DPT
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Gender | Male
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 4170 CITY AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19131-1610
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Country | US
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Telephone | 804-543-6039
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Fax |
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Provider Business Mailing Address
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Address Line | 4170 CITY AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19131-1610
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Country | US
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Telephone | 804-543-6039
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Fax |
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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 | 23052009002
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | OT021545
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License Number State | PA
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