Jackson, Charlene J.
Jackson, Charlene J. is an sole proprietor health care provider with primary practice located at 416 W 27Th St , Ashtabula OH 44004-4975. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as her primary health care specialty. Jackson, Charlene J. can be contacted via phone (440) 997-5427.Contact Information
Primary practice address
416 W 27Th St
Ashtabula OH 44004-4975
Phone: (440) 997-5427
Fax: (440) 997-5486
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X | PT01263 | Ohio |
Profile Details
| NPI number | 1417073552 |
|---|---|
| LBN Legal business name | Jackson, Charlene J. |
| Credentials | Physical Therapist (PT) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 21st, 2007 |
| Last updated | Apr 2nd, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1417073552 | NPPES |
| Ohio | MEDICAID | 0747777 |
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