Provider Demographics
NPI:1508852278
Name:JACKSON, DARBI S (PT)
Entity Type:Individual
Prefix:
First Name:DARBI
Middle Name:S
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1711 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:AL
Mailing Address - Zip Code:36545-2425
Mailing Address - Country:US
Mailing Address - Phone:251-246-5761
Mailing Address - Fax:251-246-5665
Practice Address - Street 1:4300 W MAIN ST STE 14
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1311
Practice Address - Country:US
Practice Address - Phone:334-758-8288
Practice Address - Fax:334-758-6988
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3831225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890011690Medicaid
AL890011700Medicaid
ALPTH3831OtherSTATE PHYSICAL THERAPIST LICENSE
AL890011680Medicaid
AL212412Medicaid