Provider Demographics
NPI:1932295375
Name:JACKSON, SHEILA J (RKT, CDRS)
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:J
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RKT, CDRS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:13505 WINDING TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-5830
Mailing Address - Country:US
Mailing Address - Phone:301-603-0255
Mailing Address - Fax:410-605-7680
Practice Address - Street 1:10 N GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1524
Practice Address - Country:US
Practice Address - Phone:410-605-7000
Practice Address - Fax:410-605-7680
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1332226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist