Individual
JUSTIN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
22 EUGENIA CT, CORDOVA, SC 29039-9635
(803) 707-5824
Mailing address
22 EUGENIA CT, CORDOVA, SC 29039-9635
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
4014
SC
Other
Enumeration date
04/12/2019
Last updated
04/12/2019
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