Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1332 | NY |
NPI | 1932295375 |
---|---|
Provider Name | Ms. Sheila J. Jackson |
First Address | Silver Spring, MD 20906-5830 |
Second Address | Baltimore, MD 21201-1524 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 10/06/2008 |