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Individual
MARK FRANKLIN JACKSON
Active
Individual
MARK FRANKLIN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T., DPT, MPS, OCS
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
020487
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000142682
EXCELLUS BCBS
NY
01
—
4123843
MVP
NY
01
—
7475387
AETNA US HEALTHCARE
NY
Enumeration date
01/18/2007
Last updated
02/27/2012
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