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General NPI Number Information
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NPI Number | 1962620021
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Entity Type | Individual
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Provider Name | MARY JILL JACKSON PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5000 HOPYARD RD 220
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City | PLEASANTON
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State | CA
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Zip | 94588-3348
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Country | US
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Telephone | 800-493-2988
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Fax |
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Provider Business Mailing Address
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Address Line | 1546 HAVILAND PL
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City | CLAYTON
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State | CA
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Zip | 94517-1049
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Country | US
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Telephone | 970-222-5898
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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 | 32473
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License Number State | CA
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