Breanna S Jackson
Individual provider Active NPI Physical Therapy Assistant · Kanab, UT
NPI 1194505248 · NPPES record last updated Oct 4, 2023
Key facts
- NPI
- 1194505248
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 10195848-2402 (UT)
- Practice address
- 355 N Main St Ste 103
Kanab, UT 84741-3260 - Phone
- (435) 644-4199
- NPI assigned
- Oct 4, 2023
- Sex
- Female
- 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 |
|---|---|---|---|
| 10195848-2402 | UT | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 10195848-2402 | UT | Yes |
Addresses
Primary practice location
355 N Main St Ste 103
Kanab, UT 84741-3260
Mailing address
608 E Cedar Cir
Kanab, UT 84741-3837
Phone (435) 851-1283
Other providers in Kanab, UT
- Reggie Michael Gillins
- Rebecca Gurr
- Kendra Eileen Hafen
- High Desert Chiropractic and Wellness, PC
- Helen J. Hunter
- Brittney Alta Johnson
- Karsten Michael Josie
- Crissy Judd
- Kanab Dental Center
- Kanab Healthcare LLC
All providers in Kanab, UT · Physical Therapy Assistant in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 4, 2023. 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.