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Individual
ROBERT JACKSON
Active
Individual
ROBERT JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Taxonomy
Speciality
Code
Description
License number
State
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
2119678
TX
Other
Enumeration date
01/29/2019
Last updated
01/29/2019
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