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General NPI Number Information
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NPI Number | 1669377685
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Entity Type | Individual
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Provider Name | JOSCELISE ISABELLA JACKSON DPT
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Gender | Female
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Dates
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Enumeration Date | 10/09/2026
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Last Update Date | 10/09/2026
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Provider Practice Location Address
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Address Line | 4301 HIGHWAY 7 STE 155
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-5807
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Country | US
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Telephone | 952-208-7172
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Fax | 763-356-4104
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Provider Business Mailing Address
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Address Line | 4301 HIGHWAY 7 STE 155
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-5807
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Country | US
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Telephone | 952-208-7172
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Fax | 763-356-4104
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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 | 310797
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License Number State | CA
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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 | 14601
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License Number State | MN
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