Individual
DR. EMILY ANASTASYA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT, LAT, ATC
Contact information
Practice address
22505 LANDMARK CT # 215, ASHBURN, VA 20148-6500
(703) 726-1616
Mailing address
3035 BOONE TRAIL EXT STE A, FAYETTEVILLE, NC 28304-3860
(910) 900-3814
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
P24684
NC
2255A2300X
Athletic Trainer
Primary
0126003757
VA
2255A2300X
Athletic Trainer
LAT-6216
NC
Other
Enumeration date
07/08/2020
Last updated
05/05/2026
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