Provider Demographics
NPI:1295612927
Name:JACKSON, CAMRYN (PT, DPT)
Entity type:Individual
Prefix:
First Name:CAMRYN
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 1:1303 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-1635
Mailing Address - Country:US
Mailing Address - Phone:850-321-4443
Mailing Address - Fax:850-378-4530
Practice Address - Street 1:1303 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-1635
Practice Address - Country:US
Practice Address - Phone:850-321-4443
Practice Address - Fax:850-378-4530
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist