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NPI Code Detail

MEDICARE: LEAH JACKSON PTA

MEDICARE: LEAH JACKSON PTA
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 Assistant2148986TX

General Provider Information

NPI Number : 1376177576
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEAH JACKSON PTA
Provider Business Mailing Address
First Line : 14302 NEMO CT
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78418-6238
Country : US
Telephone Number : 361-949-9898
Fax Number :
Provider Business Practice Location Address
First Line : 14302 NEMO CT
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78418-6238
Country : US
Telephone Number : 361-949-9898
Fax Number : 361-949-9897
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2020
Last Update Date : 02/26/2020

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Directions to “ LEAH JACKSON PTA” Practice Location

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