Provider Demographics
NPI:1972187961
Name:EMERSON, JACK R (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:R
Last Name:EMERSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 DESALES ST NW FL 6
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-4405
Mailing Address - Country:US
Mailing Address - Phone:202-630-0378
Mailing Address - Fax:
Practice Address - Street 1:1705 DESALES ST NW FL 6
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-4405
Practice Address - Country:US
Practice Address - Phone:202-630-0378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist