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General NPI Number Information
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NPI Number | 1447209630
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Entity Type | Individual
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Provider Name | BRANDI L JACKSON DPT
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Gender | Female
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 08/24/2022
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Provider Practice Location Address
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Address Line | 5501 NW 62ND TER STE 102
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City | KANSAS CITY
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State | MO
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Zip | 64151-2412
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Country | US
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Telephone | 816-453-4485
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Fax | 816-453-4101
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Provider Business Mailing Address
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Address Line | 5501 NW 62ND TER STE 102
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City | KANSAS CITY
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State | MO
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Zip | 64151-2412
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Country | US
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Telephone | 816-453-4485
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Fax | 816-453-4101
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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 | 2002030223
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License Number State | MO
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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 | 11-03206
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License Number State | KS
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