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NPI Code Detail

MEDICARE: KRISTEN A JACKSON PT,DPT

MEDICARE: KRISTEN A JACKSON PT,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
12251X0800XOrthopedic Physical Therapist220961806MO
2225100000XPhysical Therapist070-017006IL

General Provider Information

NPI Number : 1912098252
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN A JACKSON PT,DPT
Provider Business Mailing Address
First Line : 6255 S ARCHER AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60638-2609
Country : US
Telephone Number : 773-284-6735
Fax Number : 773-284-6820
Provider Business Practice Location Address
First Line : 6255 S ARCHER AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60638-2609
Country : US
Telephone Number : 773-284-6735
Fax Number : 773-284-6820
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 09/30/2011

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Directions to “ KRISTEN A JACKSON PT,DPT” Practice Location

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