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General NPI Number Information
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NPI Number | 1649129800
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Entity Type | Individual
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Provider Name | ADRIAN D. JACKSON
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Gender | Male
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Dates
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Enumeration Date | 01/22/2026
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 3540 S 43RD ST
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City | MILWAUKEE
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State | WI
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Zip | 53220-1502
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Country | US
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Telephone | 414-541-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 11221 SYNERGY DR # A-466
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City | MILWAUKEE
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State | WI
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Zip | 53222-1353
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 4214-19
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License Number State | WI
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