Organization
JACKSON REHAB SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN PHILLIP JACKSON OTR (PRESIDENT)
(806) 778-9735
Entity
Organization
Contact information
Practice address
5728 67TH ST, LUBBOCK, TX 79424-1406
(806) 778-9735
Mailing address
5728 67TH ST, LUBBOCK, TX 79424-1406
(806) 778-9735
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
102473
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0077JN
BLUE CROSS - OT
TX
Enumeration date
01/28/2007
Last updated
08/22/2020
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