Herman L Jackson, PTA
Physical Therapy Assistant in New York City, NY. Individual provider (NPI-1).
NPI number1013423391
StatusActive
Last updated in NPPESDec 21, 2017
Details
- NPI
- 1013423391
- Entity type
- Individual (NPI-1)
- Name
- Mr. Herman L Jackson
- Credential
- PTA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Dec 21, 2017
- Last updated
- Dec 21, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225200000X | Physical Therapy Assistant | 008098 | NY | Yes |
Practice location
Physical Therapy Of Harlem 1400 5th AveNew York City, NY 10026
Phone 212-996-3303 · Fax 212-996-9686
Mailing address
24 E 109th St Apt 1aNew York, NY 10029-3472
Phone 347-680-2272
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