Provider Demographics
NPI:1033359237
Name:JACKSON, NANCY PRITCHARD (MPT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:PRITCHARD
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:ANN
Other - Last Name:PRITCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:800-944-9782
Mailing Address - Fax:610-438-2024
Practice Address - Street 1:950 TRAVELERS BLVD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8213
Practice Address - Country:US
Practice Address - Phone:843-832-8481
Practice Address - Fax:843-832-8621
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist