Provider Demographics
NPI:1841426988
Name:HUCKS, JACKIE ELIZABETH (PTA)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:ELIZABETH
Last Name:HUCKS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 IMBODEN DR
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-5343
Mailing Address - Country:US
Mailing Address - Phone:434-996-4008
Mailing Address - Fax:
Practice Address - Street 1:100 E RHODE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-4935
Practice Address - Country:US
Practice Address - Phone:910-692-0371
Practice Address - Fax:910-692-0346
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602557225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant