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General NPI Number Information
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NPI Number | 1225115256
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Entity Type | Individual
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Provider Name | REID JACKMAN P.T.
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4550 COFFEE RD STE. H
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City | BAKERSFIELD
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State | CA
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Zip | 93308-5023
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Country | US
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Telephone | 661-587-0700
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Fax | 661-587-0799
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Provider Business Mailing Address
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Address Line | 5801 FRIANT DR
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City | BAKERSFIELD
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State | CA
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Zip | 93309-1911
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Country | US
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Telephone | 661-861-0950
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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 | PT8859
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License Number State | CA
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