| Organization Name: | ACTION JACKSON PHYSICAL THERAPY, P.C. |
| NPI Number: | 1255700555 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHANE LORAN JACKSON (OWNER/PHYSICAL THERAPIST) |
| Mailing Address: | 2844 Summit St Suite 106 Oakland |
| State: | CA US |
| Postal Code: | 946093637 |
| Phone Number: | 5107633005 |
| Fax Number: | |
| NPI Enumeration Date: | 09/17/2015 |
| NPI Last Update Date: | 09/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT23897 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| 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 |