Provider Demographics
NPI:1386822963
Name:JACKSON, CINDY B (PT)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:B
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 ROXBURY CT
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1511
Mailing Address - Country:US
Mailing Address - Phone:203-271-3288
Mailing Address - Fax:203-271-3288
Practice Address - Street 1:46 ROXBURY CT
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-1511
Practice Address - Country:US
Practice Address - Phone:203-271-3288
Practice Address - Fax:203-271-3288
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT25842251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics