NPI 1033365002

Kelly Nicole Jackson, PTA

Practitioner Physical Therapy Assistant Omaha, NE

Practice location

Address: 2085 N 120th St Suite D8, Omaha, NE 68164-3479
Phone: (402) 445-4335
Fax: (402) 445-6162
Mailing address: 8464 Orchard Ave, Omaha, NE 68127-2606

Registered specialties

Physical Therapy Assistant Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225200000X Licence NE733 (NE)

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Registry record

NPI: 1033365002
Entity type: Individual
Sex (as registered): Female
NPI issued: 11 Aug 2008
Record last updated: 11 Aug 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.