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NPI Code Detail

MEDICARE: JULIE JACKSON

MEDICARE: JULIE JACKSON
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
1225200000XPhysical Therapy Assistant821-019WI

Other Identifiers

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

General Provider Information

NPI Number : 1184838542
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE JACKSON
Provider Business Mailing Address
First Line : N1399 DILL RD
Second Line :
City : BROWNTOWN
State : WI
Zip : 53522-9760
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 516 26TH AVE
Second Line :
City : MONROE
State : WI
Zip : 53566-1531
Country : US
Telephone Number : 608-325-9141
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2007
Last Update Date : 07/08/2007

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