Provider Demographics
NPI:1356556773
Name:JACKSON THERAPY PARTNERS
Entity type:Organization
Organization Name:JACKSON THERAPY PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATIONAL ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:HEWETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-896-3660
Mailing Address - Street 1:107 BECKETT CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-2503
Mailing Address - Country:US
Mailing Address - Phone:803-665-9789
Mailing Address - Fax:
Practice Address - Street 1:1013 S BRYAN RD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6608
Practice Address - Country:US
Practice Address - Phone:956-580-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2060002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility