Provider Demographics
NPI:1285151589
Name:JACKOWSKI, AARON JOSEPH (DPT)
Entity type:Individual
Prefix:MR
First Name:AARON
Middle Name:JOSEPH
Last Name:JACKOWSKI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:MR
Other - First Name:AARON
Other - Middle Name:JOSHEPH
Other - Last Name:JACKOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:9166 MARION DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-9177
Mailing Address - Country:US
Mailing Address - Phone:231-878-1595
Mailing Address - Fax:231-876-1246
Practice Address - Street 1:1806 E PARKDALE AVE STE 1
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-9364
Practice Address - Country:US
Practice Address - Phone:231-723-5479
Practice Address - Fax:231-723-3586
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist