Provider Demographics
NPI:1508922279
Name:JACKSON, VALERIE B (PT)
Entity Type:Individual
Prefix:
First Name:VALERIE
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 1:525 SOUTH DR STE 211
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4211
Mailing Address - Country:US
Mailing Address - Phone:650-934-0455
Mailing Address - Fax:
Practice Address - Street 1:525 SOUTH DR STE 211
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4211
Practice Address - Country:US
Practice Address - Phone:650-934-0455
Practice Address - Fax:650-934-0456
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA151422251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic