Jackson, Mark Franklin

Jackson, Mark Franklin is an individual health care provider with primary practice located at 10 Brentwood Dr Suite A, Ithaca NY 14850-1865. 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, Mark Franklin can be contacted via phone (607) 274-4159.

Contact Information

Primary practice address
10 Brentwood Dr Suite A Ithaca NY 14850-1865
Phone: (607) 274-4159
Fax: (607) 274-4675
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 020487 New York

Profile Details

NPI number 1467504365
LBN Legal business name Jackson, Mark Franklin
Credentials P.T., DPT, MPS, OCS
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 18th, 2007
Last updated Feb 27th, 2012 - about 12 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 1467504365 NPPES
New York Other 000142682 EXCELLUS BCBS
New York Other 7475387 EXCELLUS BCBS
New York Other 4123843 EXCELLUS BCBS

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