Provider Demographics
NPI:1083445910
Name:JACKSON, ERIKA RAE (DPT, PT)
Entity type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:RAE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 N FEDERAL HWY BLDG 14-205
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1781
Mailing Address - Country:US
Mailing Address - Phone:484-651-2213
Mailing Address - Fax:
Practice Address - Street 1:7801 N FEDERAL HWY BLDG 14-205
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1781
Practice Address - Country:US
Practice Address - Phone:484-651-2213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41373225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist