Provider Demographics
NPI:1043019169
Name:JACKSON, JENNIFER DESORMEAU (PT,MSPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DESORMEAU
Last Name:JACKSON
Suffix:
Gender:
Credentials:PT,MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:ASSONET
Mailing Address - State:MA
Mailing Address - Zip Code:02702-1377
Mailing Address - Country:US
Mailing Address - Phone:781-526-5948
Mailing Address - Fax:
Practice Address - Street 1:4263 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-1714
Practice Address - Country:US
Practice Address - Phone:774-955-5830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist