MEDICARE: CAMERON 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	11-06988	KS

General Provider Information

NPI Number	:	1700509247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERON JACKSON DPT

Provider Business Mailing Address
First Line	:	603 AMES ST
Second Line	:
City	:	BALDWIN CITY
State	:	KS
Zip	:	66006-5200
Country	:	US
Telephone Number	:	785-594-4894
Fax Number	:	786-594-2597

Provider Business Practice Location Address
First Line	:	603 AMES ST
Second Line	:
City	:	BALDWIN CITY
State	:	KS
Zip	:	66006-5200
Country	:	US
Telephone Number	:	785-594-4894
Fax Number	:	785-594-2597

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

Provider Enumeration Date	:	09/20/2022
Last Update Date	:	09/24/2025

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Directions to “ CAMERON JACKSON DPT” Practice Location

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