Provider Demographics
NPI:1629467956
Name:JACKSON, BRITNI (PT)
Entity Type:Individual
Prefix:
First Name:BRITNI
Middle Name:
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 1:114 S 20TH AVE W
Mailing Address - Street 2:SUITE A
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55806-3526
Mailing Address - Country:US
Mailing Address - Phone:218-721-4732
Mailing Address - Fax:218-491-7185
Practice Address - Street 1:114 S 20TH AVE W
Practice Address - Street 2:SUITE A
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55806-3526
Practice Address - Country:US
Practice Address - Phone:218-721-4732
Practice Address - Fax:218-491-7185
Is Sole Proprietor?:No
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist