Provider Demographics
NPI:1689702128
Name:JACKSON, JULIE D (PT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:D
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 1:2750 MOUNT PLEASANT ST # 104
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-2136
Mailing Address - Country:US
Mailing Address - Phone:319-752-7727
Mailing Address - Fax:
Practice Address - Street 1:2750 MOUNT PLEASANT ST # 104
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-2136
Practice Address - Country:US
Practice Address - Phone:319-752-7727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist