Individual
CHANDA D'RIECE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
100 S 2ND STREET, THOMAS, OK 73669
(580) 661-2639
(580) 661-2640
Mailing address
PO BOX 797, THOMAS, OK 73669-0797
(580) 661-2639
(580) 661-2640
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3728
OK
Other
Enumeration date
06/28/2006
Last updated
03/18/2014
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