Provider Demographics
NPI:1588848576
Name:JACKSON, NATALIE R (DPT)
Entity type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:R
Last Name:JACKSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 HARTNELL AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1846
Mailing Address - Country:US
Mailing Address - Phone:530-226-9242
Mailing Address - Fax:530-226-9070
Practice Address - Street 1:320 HARTNELL AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1846
Practice Address - Country:US
Practice Address - Phone:530-226-9242
Practice Address - Fax:530-226-9070
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist