| Doctor Name: | MR. JASON JACKSON |
| NPI Number: | 1033290226 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | P.T. |
| License Number: | 020225 |
| Business Practice Address: | 1468 Madison Avenue New York, NY - 100296574 |
| Business Phone Number: | 2122418045 |
| Business Fax Number: | |
| Mailing Address: | 257 W 121st St, NEW YORK |
| State: | NY |
| Postal Code: | 100276218 |
| Phone Number: | 2122418045 |
| Fax Number: | 2128601093 |
| NPI Enumeration Date: | 10/17/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 020225 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |