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General NPI Number Information
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NPI Number | 1982576773
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Entity Type | Individual
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Provider Name | KATIE JACKSON PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 09/22/2025
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 2613 PEPPERELL PKWY
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City | OPELIKA
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State | AL
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Zip | 36801-6121
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Country | US
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Telephone | 706-341-3641
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Fax |
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Provider Business Mailing Address
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Address Line | 1848 QUAIL HOLW
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City | AUBURN
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State | AL
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Zip | 36830-2557
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTH12449
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License Number State | AL
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