Jackson, Phyliss L
Jackson, Phyliss L is an sole proprietor health care provider with primary practice located at 1 Adventist Health Way , Roseville CA 95661-3266. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Massage Therapist, which is considered as her primary health care specialty. Jackson, Phyliss L can be contacted via phone (916) 406-0177.Contact Information
Primary practice address
1 Adventist Health Way
Roseville CA 95661-3266
Phone: (916) 406-0177
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Massage Therapist | 225700000X | 80744 | California |
Profile Details
| NPI number | 1326672494 |
|---|---|
| LBN Legal business name | Jackson, Phyliss L |
| Credentials | LCMT,HE |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 27th, 2020 |
| Last updated | Feb 27th, 2020 - 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1326672494 | NPPES |
| California | MEDICAID | B4915041 |
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