| Doctor Name: | MR. KYLE JACKSON |
| NPI Number: | 1861597908 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | PT27666 |
| Business Practice Address: | 1310 Casa Grande Rd Suite B Petaluma, CA - 949545603 |
| Business Phone Number: | 7077820921 |
| Business Fax Number: | 7077820926 |
| Mailing Address: | Po Box 10, WINDSOR |
| State: | CA |
| Postal Code: | 954920010 |
| Phone Number: | 7078377980 |
| Fax Number: | 7078377983 |
| NPI Enumeration Date: | 09/13/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT27666 |
| 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 |