MEDICARE: MS. VELMA L. JACKSON P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1002194	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023025921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VELMA L. JACKSON P.T.

Provider Business Mailing Address
First Line	:	P.O. BOX 14685
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77221-4685
Country	:	US
Telephone Number	:	713-747-1012
Fax Number	:

Provider Business Practice Location Address
First Line	:	4035 GLEN COVE DR.
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77021
Country	:	US
Telephone Number	:	713-747-1012
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	08/25/2009

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