Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Ethan Gainor Jackson, PT, DPT

Individual provider Physical Therapist · NPI 1891210456

Ethan Gainor Jackson, PT, DPT is a Physical Therapist in Lawrenceville, Georgia. Licensed in Georgia. Registered with an NPI since 2017.

Licensed in
GA
In the registry since
2017
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

455 Philip Blvd Bldg 100-160
Lawrenceville, GA 30046-8767
Phone: (678) 985-0238
Fax: (678) 985-0136
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence PT013032 (GA)

Record details

NPI number1891210456
Entity typeIndividual (Type 1)
GenderMale
Credentials PT , DPT
Sole proprietorNo
NPI enumeratedAugust 4, 2017
Last updated in NPPESAugust 4, 2017

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