Provider Demographics
NPI:1134338817
Name:JACKSON, REBECCA LEIGH (PT)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LEIGH
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 KENSINGTON LN
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-3903
Mailing Address - Country:US
Mailing Address - Phone:205-956-4150
Mailing Address - Fax:205-951-0017
Practice Address - Street 1:100 SHADOW WOOD PARK STE B
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-3447
Practice Address - Country:US
Practice Address - Phone:205-982-4770
Practice Address - Fax:205-982-1389
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist