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General NPI Number Information
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NPI Number | 1407647274
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Entity Type | Individual
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Provider Name | RHANDI JACKSON
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Gender | Female
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 180 SE HIGHWAY 224
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City | ESTACADA
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State | OR
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Zip | 97023-7022
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Country | US
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Telephone | 503-698-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 655 S WILLOW ST
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City | MANCHESTER
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State | NH
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Zip | 03103-5714
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Country | US
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Telephone |
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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 | 1346277
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 307507
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CP037015T
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CP044280T
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License Number State | OR
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