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General NPI Number Information
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NPI Number | 1366555211
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Entity Type | Individual
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Provider Name | ERIN HOSIE JACKSON MSPT, CPI
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Gender | Female
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 12/22/2010
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Provider Practice Location Address
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Address Line | 1100 S COAST HWY SUITE 301 B
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-2968
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Country | US
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Telephone | 949-494-3200
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Fax | 949-494-3222
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Provider Business Mailing Address
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Address Line | 11 BANEBERRY
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City | ALISO VIEJO
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State | CA
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Zip | 92656-2147
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Country | US
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Telephone | 949-716-9616
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Fax | 949-494-3222
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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 | 20223
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License Number State | CA
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