Provider Demographics
NPI:1518599786
Name:JACKSON, MEGHAN E (DPT)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:E
Last Name:JACKSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:
Other - Last Name:GURLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:781 BAYRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095-4241
Mailing Address - Country:US
Mailing Address - Phone:440-463-8612
Mailing Address - Fax:
Practice Address - Street 1:781 BAYRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:WILLOWICK
Practice Address - State:OH
Practice Address - Zip Code:44095-4241
Practice Address - Country:US
Practice Address - Phone:440-463-8612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT012159261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy