Provider Demographics
NPI:1740678242
Name:JACKSON THERAPY
Entity type:Organization
Organization Name:JACKSON THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECRUITER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANINFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-308-3874
Mailing Address - Street 1:109 LEAF LN
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-1037
Mailing Address - Country:US
Mailing Address - Phone:814-201-4059
Mailing Address - Fax:
Practice Address - Street 1:109 LEAF LN
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-1037
Practice Address - Country:US
Practice Address - Phone:814-201-4059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation