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Individual
NATHANIEL JACKSON
Active
Individual
NATHANIEL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
P11832
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P11832
PT LICENSE
NC
Enumeration date
09/24/2008
Last updated
04/23/2009
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