Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | TEI002837 | PA |
NPI | 1013457571 |
---|---|
Provider Name | Brandy Jackson |
First Address | Chambersburg, PA 17201-1013 |
Second Address | Chambersburg, PA 17201-2207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2017 |
Last Update Date | 03/03/2017 |