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General NPI Number Information
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NPI Number | 1992290795
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Entity Type | Individual
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Provider Name | REGGINALD JACKSON
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Gender | Male
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 10173 SW JUDY AVE
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City | ARCADIA
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State | FL
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Zip | 34269-4496
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Country | US
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Telephone | 405-830-8330
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Fax |
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Provider Business Mailing Address
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Address Line | 10173 SW JUDY AVE
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City | ARCADIA
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State | FL
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Zip | 34269-4496
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Country | US
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Telephone | 405-830-8330
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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 | PT41459
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License Number State | FL
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