Provider Demographics
NPI:1972850238
Name:JACKSON PHYSICAL THERAPY & ASSOCIATES, INC
Entity Type:Organization
Organization Name:JACKSON PHYSICAL THERAPY & ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:812-246-8975
Mailing Address - Street 1:326 N INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-1223
Mailing Address - Country:US
Mailing Address - Phone:812-246-8975
Mailing Address - Fax:812-246-8977
Practice Address - Street 1:326 N INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-1223
Practice Address - Country:US
Practice Address - Phone:812-246-8975
Practice Address - Fax:812-246-8977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty