Provider Demographics
NPI:1891512935
Name:JACKSON, ELIZABETH DIANNE (PT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:DIANNE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1538
Mailing Address - Country:US
Mailing Address - Phone:615-342-5600
Mailing Address - Fax:615-342-5609
Practice Address - Street 1:2410 PATTERSON ST STE 100
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1674
Practice Address - Country:US
Practice Address - Phone:615-342-5600
Practice Address - Fax:615-342-5600
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist