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NPI Code Detail

MEDICARE: DANIEL SHANE JACKSON DPT

MEDICARE: DANIEL SHANE 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 Therapist2002029465MO
2225100000XPhysical Therapist11-03205KS

General Provider Information

NPI Number : 1952301756
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL SHANE JACKSON DPT
Provider Business Mailing Address
First Line : 5501 NW 62ND TER STE 102
Second Line :
City : KANSAS CITY
State : MO
Zip : 64151-2412
Country : US
Telephone Number : 816-453-4485
Fax Number : 816-453-4101
Provider Business Practice Location Address
First Line : 5501 NW 62ND TER STE 102
Second Line :
City : KANSAS CITY
State : MO
Zip : 64151-2412
Country : US
Telephone Number : 816-453-4485
Fax Number : 816-453-4101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2005
Last Update Date : 10/06/2022

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Directions to “ DANIEL SHANE JACKSON DPT” Practice Location

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