Basic Information
| Provider Information | |||||||||
| NPI: | 1912378977 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE JACKSON CLINICS LP | ||||||||
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| OtherOrganizationName: | THE JACKSON CLINICS LP | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1769 | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 20118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406878181 | ||||||||
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| Practice Location | |||||||||
| Address1: | 119 THE PLAINS ROAD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MIDDLEBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 20118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406878181 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2015 | ||||||||
| LastUpdateDate: | 10/15/2015 | ||||||||
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| AuthorizedOfficialLastName: | WHITE | ||||||||
| AuthorizedOfficialFirstName: | BOBBI | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 5406878181 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | USPH | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.