Provider Demographics
NPI:1205674652
Name:JACKSON, ERIKA (PT)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
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 1:609 WAVERLY ST APT 453
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-4515
Mailing Address - Country:US
Mailing Address - Phone:240-695-2884
Mailing Address - Fax:929-290-0328
Practice Address - Street 1:609 WAVERLY ST
Practice Address - Street 2:UNIT 453
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-4515
Practice Address - Country:US
Practice Address - Phone:240-695-2884
Practice Address - Fax:929-290-0328
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1261841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty