NPI 1235263963

Michelle Dianne Jackson, PT

Practitioner Physical Therapist Largo, MD

Practice location

Address: 1221 Mercantile Ln, Largo, MD 20774-5374
Phone: (301) 618-5552
Fax: (301) 816-7170
Mailing address: 2101 E Jefferson St Kaiser Permanente Attn:sanjay Mathur 3 W Data Mnmgt DPT, Rockville, MD 20852-4908

Registered specialties

Physical Therapist Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225100000X Licence 15783 (MD)

Other Physical Therapist providers in Maryland →

Registry record

NPI: 1235263963
Entity type: Individual
Sex (as registered): Female
NPI issued: 15 Mar 2007
Record last updated: 8 Jul 2007

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.