Doctor Name: | DEONTE RAY JACKSON |
NPI Number: | 1285984096 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 1385 European Dr Henderson, NV - 890524021 |
Business Phone Number: | 7027380206 |
Business Fax Number: | |
Mailing Address: | 1385 European Dr, HENDERSON |
State: | NV |
Postal Code: | 890524021 |
Phone Number: | 7027380206 |
Fax Number: | |
NPI Enumeration Date: | 09/19/2012 |
NPI Last Update Date: | 09/19/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225400000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Rehabilitation Practitioner |
Taxonomy Specialization: | |
Taxonomy Definition: | A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity. |