National Provider Identifier
John Leonard Jackson
John Leonard Jackson is listed in the NPPES registry with a primary specialty of Athletic Trainer in Brockport, NY and a listed phone number of (585) 395-5374.
Profile Overview
- NPI
- 1609482702
- Provider Type
- Individual
- Primary Specialty
- Athletic Trainer
- Enumeration Date
- September 23, 2020
- Last Updated
- September 23, 2020
Practice Location
- 350 New Campus Dr
- Brockport, NY 14420-2997
Phone: (585) 395-5374
Specialties
- Athletic Trainer (2255A2300X)
Endpoints
- jjackson@brockport.edu
Connect Url | Direct | Other | Brockport, NY 14420
Email
Full Record
- NPI
- 1609482702
- Entity Type
- Individual
- Last Name
- Jackson
- First Name
- John
- Middle Name
- Leonard
- Mailing Street Address
- 350 New Campus Dr
- Mailing City
- Brockport
- Mailing State
- NY
- Mailing ZIP Code
- 14420-2997
- Mailing Country
- US
- Mailing Phone
- (585) 395-5374
- Practice Street Address
- 350 New Campus Dr
- Practice City
- Brockport
- Practice State
- NY
- Practice ZIP Code
- 14420-2997
- Practice Country
- US
- Practice Phone
- (585) 395-5374
- Enumeration Date
- September 23, 2020
- Last Updated
- September 23, 2020
- Sex
- Male
- Sole Proprietor
- No
- Certification Date
- September 23, 2020
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Athletic Trainer (2255A2300X)