Doctor Name: | DR. ERICK LARON JACKSON |
NPI Number: | 1952730491 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPT |
License Number: | 2305208116 |
Business Practice Address: | 5788 Churchland Blvd Portsmouth, VA - 237033309 |
Business Phone Number: | 7573922673 |
Business Fax Number: | 7573922655 |
Mailing Address: | 94 Madison Chase, HAMPTON |
State: | VA |
Postal Code: | 236666119 |
Phone Number: | 7573449981 |
Fax Number: | 7573922673 |
NPI Enumeration Date: | 11/05/2013 |
NPI Last Update Date: | 11/05/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 2305208116 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
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 |