MEDICARE: LUKE MICHAEL 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
1	225200000X	Physical Therapy Assistant	34560	FL

General Provider Information

NPI Number	:	1639028053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUKE MICHAEL JACKSON

Provider Business Mailing Address
First Line	:	7744 SW 100TH RUN
Second Line	:
City	:	LAKE BUTLER
State	:	FL
Zip	:	32054-6410
Country	:	US
Telephone Number	:	904-796-7726
Fax Number	:

Provider Business Practice Location Address
First Line	:	7744 SW 100TH RUN
Second Line	:
City	:	LAKE BUTLER
State	:	FL
Zip	:	32054-6410
Country	:	US
Telephone Number	:	904-796-7726
Fax Number	:

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

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/27/2026

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Directions to “ LUKE MICHAEL JACKSON ” Practice Location

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