David Jackson Jr., PTA
Individual provider Active NPI Physical Therapy Assistant · Lake City, SC
NPI 1104098904 · NPPES record last updated Apr 1, 2008
Key facts
- NPI
- 1104098904
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 1706 (SC)
- Practice address
- 258 N Ron McNair Blvd
Lake City, SC 29560-2462 - Phone
- (843) 374-6198
- Fax
- (843) 374-6180
- NPI assigned
- Apr 1, 2008
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1706 | SC | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 1706 | SC | Yes |
Addresses
Primary practice location
258 N Ron McNair Blvd
Lake City, SC 29560-2462
Mailing address
258 N Ron McNair Blvd
Lake City, SC 29560-2462
Phone (843) 374-6198
Other providers in Lake City, SC
- Hopehealth, Inc
- Hopehealth, Inc
- T'Auna Hudson
- Ih3 Physcial Therapy
- Linda Teresa Jackosn
- Paul Wells James
- Kirby Rebekah Jeffords
- Carlon Darneil Jenkins
- Sheriko Jernigan
- Bonita D Johnson
All providers in Lake City, SC · Physical Therapy Assistant in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 1, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.