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NPI Code Detail

MEDICARE: AMY JACKSON P.T.

MEDICARE: AMY 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
1225100000XPhysical TherapistPT-10851OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000362244OTHEROHANTHEM PROVIDER NUMBER

General Provider Information

NPI Number : 1629113600
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY JACKSON P.T.
Provider Business Mailing Address
First Line : 2315 STONYBROOK BLVD
Second Line :
City : SYLVANIA
State : OH
Zip : 43560-8905
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1609 N SUMMIT ST
Second Line :
City : TOLEDO
State : OH
Zip : 43604-1806
Country : US
Telephone Number : 419-671-0001
Fax Number : 419-539-0288
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2007
Last Update Date : 05/22/2025

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