PHYLISS L JACKSON (NPI# 1326672494) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326672494 |
| Entity Type | Individual |
| Full Name | PHYLISS L JACKSON |
| Credential | LCMT,HE |
| Practice Address |
1 Adventist Health Way Roseville CA 95661-3266 |
| Mailing Address |
2201 Arena Blvd Apt 7106 Sacramento CA 95834-7940 |
| Practice Telephone | 9164060177 |
| Mailing Telephone | 9167069892 |
| Enumeration Date | 2020-02-27 |
| Last Update Date | 2020-02-27 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225700000X | Massage Therapist | 80744 | CA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | B4915041 | 05 |
| Street Address |
1 ADVENTIST HEALTH WAY |
| City | ROSEVILLE |
| State | CA |
| Zip Code | 95661-3266 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194194415 | Erin Skinner | Dietitian, Registered | 1 Adventist Health Way, Roseville, CA 95661-3266 | 2015-09-16 |
| 1508489303 | Fortify Market | Pharmacy | 1 Adventist Health Way, Roseville, CA 95661-3266 | 2020-05-27 |
| 1013477413 | Adventist Health Physicians Network | Family Medicine | 1 Adventist Health Way, Roseville, CA 95678 | 2019-03-21 |
| 1316419039 | Saijun Ma | Nurse Practitioner | 1 Adventist Health Way, Roseville, CA 95661-3266 | 2018-12-19 |
| 1154783652 | Josef Mielke | Physical Therapist | 1 Adventist Health Way, Roseville, CA 95661-3266 | 2016-03-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134777816 | Aprildawn Mccarty Mccarty | Behavior Technician | 2125 Professional Dr, 100, Roseville, CA 95661 | 2019-08-27 |
| 1407409089 | David Armel Gomez Croddy | Dentist | 2740 Carradale Drive, Roseville, CA 95661 | 2019-07-22 |
| 1699335612 | Mowell | Durable Medical Equipment & Medical Supplies | 901 Sunrise, Roseville, CA 95661 | 2019-06-20 |
| 1578024998 | Mystesia Lasan Hayes | Behavior Technician | 4121 Vittorio Dr., Roseville, CA 95661 | 2019-03-28 |
| 1033676457 | The Place Within | Counselor | 720 Sunrise Ave #d115, Roseville, CO 95661 | 2019-02-21 |
| 1396217733 | Tuyen Thi Thanh Nguyen | Respiratory Therapist, Registered | Kaiser Roseville Hospital, 1600 Eureka Rd, Roseville, CA 95661 | 2018-12-26 |
| 1982179776 | Dr. Jeffrey A. Saladin, Dental Corporation | Dentist | 1565 Eureka Road, Suite 5, Roseville, CA 95661 | 2018-10-08 |
| 1184106536 | Sabita Kondle | Marriage & Family Therapist | 1528 Hope Counseling Center Ste 101, Roseville, CA 95661 | 2018-09-02 |
| 1740787837 | Sylvia A Atieno | Nurse Practitioner | Suttter Roseville Medical Center, 1 Medical Plaza, Roseville, CA 95661 | 2018-04-06 |
| 1457875296 | Good Works Psychophysiology and Physical Therapy | Physical Therapist | 1650 Leadhill Blvd, 600, Roseville, CA 95661 | 2017-08-02 |
| Find all providers in zip 95661 | ||||
| Taxonomy Code | 225700000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Massage Therapist |
| An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245838747 | Quinn Morse | Massage Therapist | 1058 Shenencock Way, Roseville, CA 95747-7512 | 2020-10-15 |
| 1093322190 | Steven Gonzalez Rodriguez | Massage Therapist | 701 Gibson Dr Apt 1612, Roseville, CA 95678-5744 | 2020-09-23 |
| 1164036885 | Emanuel Buggs | Massage Therapist | 30585 Sandhurst Dr Apt 205, Roseville, MI 48066-7724 | 2020-09-01 |
| 1326695495 | Jordan Wan | Massage Therapist | 1141 Smith Lane Ste #3, Ste #3, Roseville, OH 95661-4123 | 2019-08-22 |
| 1124593538 | Dean Samuel Pastor | Massage Therapist | 6001 Barnside Pl, Roseville, CA 95747-9616 | 2018-10-11 |
| 1184103392 | Jennifer Youssef | Massage Therapist | 18001 Biehl St, Roseville, MI 48066-2573 | 2018-08-08 |
| 1760911192 | Laura Marie Hummel | Massage Therapist | 9077 Foothills Blvd. Suite 200, Roseville, CA 95747 | 2017-06-08 |
| 1215479613 | Melonie Jackson | Massage Therapist | 26640 Belanger St, Roseville, MI 48066-3185 | 2016-11-16 |
| 1164883765 | Jeffrey Korolchuk Jr. | Massage Therapist | 2204 Lexington Ave N Apt 10, Roseville, MN 55113-4355 | 2016-03-10 |
| 1982073193 | Sherri Macmillan | Massage Therapist | 508 Gibson Drive, Ste 290, Roseville, CA 95678 | 2015-09-17 |
| Find all providers in ROSEVILLE | ||||
Please comment or provide details below to improve the information on PHYLISS L JACKSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.