Individual
JANELLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT,DPT
Contact information
Practice address
505 ELM ST NE, ALBUQUERQUE, NM 87102-2500
(505) 727-8000
Mailing address
505 ELM ST NE, ALBUQUERQUE, NM 87102-2500
(505) 727-8000
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4494
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053488494
MEDICARE NPI FOR LOVELACE REHABILITATION HOSPITAL
NM
Enumeration date
09/04/2014
Last updated
10/02/2024
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