MEDICARE: MS. KARA MARIE JACKSON DPT

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	PT025317	PA

General Provider Information

NPI Number	:	1467903336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KARA MARIE JACKSON DPT

Provider Business Mailing Address
First Line	:	7 CARNEGIE PLZ
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08003-1000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	999 OLD EAGLE SCHOOL RD STE 106
Second Line	:
City	:	WAYNE
State	:	PA
Zip	:	19087-1707
Country	:	US
Telephone Number	:	877-407-3422
Fax Number	:

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

Provider Enumeration Date	:	10/17/2016
Last Update Date	:	10/17/2016

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