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NPI Code Detail

MEDICARE: JULIE ANN JACKSON DPT

MEDICARE:   JULIE ANN 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
1225100000XPhysical Therapist62913OR
2225100000XPhysical Therapist296435CA
3225100000XPhysical TherapistPT296435CA

General Provider Information

NPI Number : 1821558032
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE ANN JACKSON DPT
Provider Business Mailing Address
First Line : 3217 MERIDIAN WAY
Second Line :
City : ROCKLIN
State : CA
Zip : 95765-4768
Country : US
Telephone Number : 541-570-2095
Fax Number :
Provider Business Practice Location Address
First Line : 1550 3RD ST
Second Line :
City : LINCOLN
State : CA
Zip : 95648-1576
Country : US
Telephone Number : 916-645-7761
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2019
Last Update Date : 05/28/2020

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Directions to “ JULIE ANN JACKSON DPT” Practice Location

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