Provider Demographics
NPI:1801036306
Name:JACKSON, JANE M (PTA)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:M
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:9097 E DESERT COVE AVE
Mailing Address - Street 2:SUITE110
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6710
Mailing Address - Country:US
Mailing Address - Phone:480-860-4298
Mailing Address - Fax:480-860-0356
Practice Address - Street 1:16838 E PALISADES BLVD
Practice Address - Street 2:BLDG B
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3845
Practice Address - Country:US
Practice Address - Phone:480-837-2595
Practice Address - Fax:480-837-2773
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ6716A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant