Provider Demographics
NPI:1598319071
Name:ADAMSON, JACKIE MARIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:MARIE
Last Name:ADAMSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5209 HORIZON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-2628
Mailing Address - Country:US
Mailing Address - Phone:307-259-8172
Mailing Address - Fax:
Practice Address - Street 1:1637 29TH AVENUE PL
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-6822
Practice Address - Country:US
Practice Address - Phone:970-356-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist