Michelle Dianne Jackson, PT

NPI #1235263963 in Largo, Maryland

Provider Information

NPI Number: 1235263963
Entity Type: Individual
Name: Michelle Dianne Jackson, PT
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapist
Credential: PT
Enumeration Date: Mar 15, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 1221 MERCANTILE LN
City: Largo
State: Maryland
ZIP Code: 20774-5374
Phone: (301) 618-5552

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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