Individual
KEITH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
21348
MD
225100000X
Physical Therapist
Primary
J1-0001883
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1530795
PABS
—
01
—
2342330000
AMERIHEALTH
—
01
—
246555
MAMSI
—
01
—
5070-0032
NCA
—
01
—
50700032
CAREFIRST
—
01
—
64343601
CARE FIRST
—
Enumeration date
06/28/2006
Last updated
09/19/2013
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