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NPI Code Detail

MEDICARE: ROBERT JACKSON

MEDICARE:   ROBERT  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
1225100000XPhysical TherapistPTH9551AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PTH9551OTHERALLICENSE

General Provider Information

NPI Number : 1538701487
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT JACKSON
Provider Business Mailing Address
First Line : 2823 GREYSTONE COMMERCIAL BLVD
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35242-2660
Country : US
Telephone Number : 205-745-3660
Fax Number :
Provider Business Practice Location Address
First Line : 3056 HEALTHY WAY STE 116
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35243-2435
Country : US
Telephone Number : 205-783-5270
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2019
Last Update Date : 10/11/2019

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Directions to “ ROBERT JACKSON ” Practice Location

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