Individual
DR. DEBORAH A JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD,PT, OCS,CMP, ATC
Contact information
Practice address
319 W TOWN PL, SUITE 5, ST AUGUSTINE, FL 32092-3101
(904) 342-5262
(904) 217-3580
Mailing address
319 W TOWN PL, SUITE 5, ST AUGUSTINE, FL 32092-3101
(904) 342-5262
(904) 217-3580
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT11000
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GE918Z
MEDICARE
—
01
—
Y5614
BCBS
—
Enumeration date
05/01/2006
Last updated
10/19/2012
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