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NPI Code Detail

MEDICARE: MS. SHANEL LOREE JACKSON P.T.

MEDICARE: MS. SHANEL LOREE 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 TherapistPT24826FL

General Provider Information

NPI Number : 1780619817
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHANEL LOREE JACKSON P.T.
Provider Business Mailing Address
First Line : 2916 ST JOHN DR
Second Line :
City : CLEARWATER
State : FL
Zip : 33759-2122
Country : US
Telephone Number : 816-241-2131
Fax Number :
Provider Business Practice Location Address
First Line : 2155 MONTCLAIR RD
Second Line :
City : CLEARWATER
State : FL
Zip : 33763-4287
Country : US
Telephone Number : 727-380-5250
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 11/06/2025

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