IndividualActive
Gabrielle Jackson
NPI 1982333472 · Physical Therapy Assistant · Sullivan, IL
Provider details
- NPI number
- 1982333472
- Entity type
- Individual
- Primary specialty
- Physical Therapy AssistantRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Sex
- Female
- Sole proprietor
- Yes
- License
- 160.007936 (IL)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
1 Masonic Way
Sullivan, IL 61951-9467
Phone: (217) 728-3700
Approximate (ZIP-level) locationGet directions
Mailing address
2128 E 1525 North Rd
Shelbyville, IL 62565-4537
Registry dates
- Enumerated
- 2022-06-09
- Last updated
- 2022-06-09
- Certified
- 2022-06-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.