Provider Demographics
NPI:1770177560
Name:JACKSON, SIERRA (PT, DPT)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 SOUTHWEST FWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7461
Mailing Address - Country:US
Mailing Address - Phone:713-223-1800
Mailing Address - Fax:
Practice Address - Street 1:5252 WESTCHESTER STREET
Practice Address - Street 2:SUITE 255
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005
Practice Address - Country:US
Practice Address - Phone:713-360-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1332214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist