Jackson-Ricketts, Damien S

Jackson-Ricketts, Damien S is an sole proprietor health care provider with primary practice located at 904 Palms Blvd , Venice CA 90291-3853. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Jackson-Ricketts, Damien S can be contacted via phone (276) 768-7816.

Contact Information

Primary practice address
904 Palms Blvd Venice CA 90291-3853
Phone: (276) 768-7816
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 293358 California

Profile Details

NPI number 1346765195
LBN Legal business name Jackson-Ricketts, Damien S
Credentials PT, DPT
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 12th, 2017
Last updated Feb 12th, 2021 - about 5 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346765195 NPPES
California Other 293358 PHYSICAL THERAPY LICENSE NUMBER

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