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Organization
BRANDON JACKSON PT
Active
Organization
BRANDON JACKSON PT
Active
Other names
Jackson Physical Therapy and Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDON L JACKSON P.T. (PHYSICAL THERAPIST)
(702) 845-1386
Entity
Organization
Contact information
Practice address
4765 S DURANGO DR, SUITE 106, LAS VEGAS, NV 89147-8145
(702) 898-7633
(702) 898-6433
Mailing address
4765 S DURANGO DR, SUITE 106, LAS VEGAS, NV 89147-8145
(702) 898-7633
(702) 898-6433
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
Primary
1365
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487682076
—
NV
Enumeration date
11/20/2013
Last updated
05/02/2014
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