Individual
KELLY ELIZABETH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
10100 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-8970
(503) 813-2000
Mailing address
5403 N HARVARD ST, PORTLAND, OR 97203-5208
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
62508
OR
Other
Enumeration date
09/12/2017
Last updated
03/05/2025
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