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General NPI Number Information
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NPI Number | 1669945465
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Entity Type | Individual
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Provider Name | HANNAH JACQUELINE JACKSON PTA
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Gender | Female
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Dates
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Enumeration Date | 01/04/2019
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Last Update Date | 05/07/2021
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Provider Practice Location Address
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Address Line | KROONTJE HEALTHCARE CENTER 100 LITTON LANE
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City | BLACKSBURG
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State | VA
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Zip | 24060
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Country | US
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Telephone | 540-443-3437
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Fax |
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Provider Business Mailing Address
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Address Line | 804 PETRA PASS
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City | BLACKSBURG
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State | VA
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Zip | 24060-8772
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Country | US
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Telephone | 540-808-9132
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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 | 2306604661
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License Number State | VA
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