Provider Demographics
NPI:1033579495
Name:JACKSON, BRITTNE R (PT, DPT, MPH)
Entity Type:Individual
Prefix:DR
First Name:BRITTNE
Middle Name:R
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PT, DPT, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9080 BEALE RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-5633
Mailing Address - Country:US
Mailing Address - Phone:301-400-2316
Mailing Address - Fax:
Practice Address - Street 1:9080 BEALE RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5600
Practice Address - Country:US
Practice Address - Phone:301-400-2316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-28
Last Update Date:2023-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD258392251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD105139360Medicaid