Tracie Lashelle Jackson, P.T., DPT
Physical Therapist in Baton Rouge, LA. Individual provider (NPI-1).
NPI number1487948154
StatusActive
Last updated in NPPESMar 19, 2014
Details
- NPI
- 1487948154
- Entity type
- Individual (NPI-1)
- Name
- Miss Tracie Lashelle Jackson
- Credential
- P.T., DPT
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 31, 2011
- Last updated
- Mar 19, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225100000X | Physical Therapist | 08369R | LA | Yes |
| 225100000X | Physical Therapist | – | – | |
| 225100000X | Physical Therapist | 010349 | GA |
Practice location
10101 Park Rowe AveSte. 200
Baton Rouge, LA 70810-1686
Phone 225-769-2200 · Fax 225-768-2185
Mailing address
Po Box 98509Baton Rouge, LA 70884-9509
Phone 225-769-2200 · Fax 225-768-2185
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