Provider Demographics
NPI:1790196541
Name:JACKSON, CLAIRE (PT)
Entity Type:Individual
Prefix:MRS
First Name:CLAIRE
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 1:85 GEORGETOWN DRIVE
Mailing Address - Street 2:APT 6
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-7523
Mailing Address - Country:US
Mailing Address - Phone:617-775-3642
Mailing Address - Fax:
Practice Address - Street 1:85 GEORGETOWN DR
Practice Address - Street 2:APT 6
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-7523
Practice Address - Country:US
Practice Address - Phone:617-775-3642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist