Individual
MRS. ALICIA LADONNA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3630 NORTHBROOK DR, NORTHPORT, AL 35473-5822
(205) 330-1001
Mailing address
4206 REVERE WAY, NORTHPORT, AL 35475-4421
(205) 330-0642
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9712
PHYSICAL THERAPY LICENSE
AL
Enumeration date
12/20/2006
Last updated
07/08/2007
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