Individual
EMMA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
22 MILL ST, SUITE 406, ARLINGTON, MA 02476-4784
(781) 646-8440
(781) 643-7542
Mailing address
1 CREDIT UNION WAY, FL. 3, RANDOLPH, MA 02368-4633
(781) 961-3370
(781) 961-1291
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
20643
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110110967A
—
MA
01
—
S400274054
MEDICARE PTAN
MA
Enumeration date
03/26/2015
Last updated
11/03/2016
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