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NPI Code Detail

MEDICARE: MRS. NINA MARIE JACKSON PT

MEDICARE:  MRS. NINA MARIE JACKSON  PT
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 Therapist2305004040VA

General Provider Information

NPI Number : 1669668612
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NINA MARIE JACKSON PT
Provider Business Mailing Address
First Line : 925 OAK TREE LN
Second Line :
City : HARRISONBURG
State : VA
Zip : 22801-4640
Country : US
Telephone Number : 540-433-0811
Fax Number : 540-434-2404
Provider Business Practice Location Address
First Line : 220 RESERVOIR ST
Second Line :
City : HARRISONBURG
State : VA
Zip : 22801-4321
Country : US
Telephone Number : 540-434-9267
Fax Number : 540-434-2404
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2007
Last Update Date : 09/21/2011

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Directions to “ MRS. NINA MARIE JACKSON PT” Practice Location

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