Provider Demographics
NPI:1821558032
Name:JACKSON, JULIE ANN (DPT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:HITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3217 MERIDIAN WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4768
Mailing Address - Country:US
Mailing Address - Phone:541-570-2095
Mailing Address - Fax:
Practice Address - Street 1:1550 3RD ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-1576
Practice Address - Country:US
Practice Address - Phone:916-645-7761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62913225100000X
CA296435225100000X
CAPT296435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist