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General NPI Number Information
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NPI Number | 1922367705
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Entity Type | Individual
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Provider Name | RITA JACKSON P.T.
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Gender | Female
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Dates
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Enumeration Date | 05/14/2012
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Last Update Date | 05/14/2012
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Provider Practice Location Address
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Address Line | 23 SKY TERRACE PL
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City | SPRING
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State | TX
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Zip | 77381-3186
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Country | US
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Telephone | 713-805-1561
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 130004
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City | SPRING
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State | TX
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Zip | 77393-0004
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Country | US
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Telephone | 713-805-1561
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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 | 1027068
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License Number State | TX
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