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Individual
MICHELE D JACKSON
Active
Individual
MICHELE D JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00009603
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0197668
DEPT OF LABOR & INDUSTRY
WA
01
—
0296927
L & I
WA
05
—
8413668
—
WA
01
—
P00303497
RAILROAD MEDICARE
WA
Enumeration date
09/13/2006
Last updated
02/07/2022
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