Provider Demographics
NPI:1235024647
Name:JACK, NKESE JAPHIA (DPT)
Entity type:Individual
Prefix:
First Name:NKESE
Middle Name:JAPHIA
Last Name:JACK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18225 KINGSDALE AVE APT 216
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4663
Mailing Address - Country:US
Mailing Address - Phone:224-292-9671
Mailing Address - Fax:
Practice Address - Street 1:3300 E SOUTH ST STE 203
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90805-4589
Practice Address - Country:US
Practice Address - Phone:526-512-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist