Provider Demographics
NPI:1811260052
Name:JACKSON, JEANNA PATRICE (DPT, ATC)
Entity type:Individual
Prefix:DR
First Name:JEANNA
Middle Name:PATRICE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 IRVING ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2921
Mailing Address - Country:US
Mailing Address - Phone:202-877-1566
Mailing Address - Fax:
Practice Address - Street 1:2021 K ST NW
Practice Address - Street 2:SUITE 750
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1003
Practice Address - Country:US
Practice Address - Phone:202-293-1853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC871328225100000X
VA2305209240225100000X
MD23935225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist