Individual
JOHN MARTIN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11118 LANTERN WAY, NORTH CHESTERFIELD, VA 23236-3575
(646) 408-0535
Mailing address
PO BOX 7523, RICHMOND, VA 23231-0023
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306602301
VA
Other
Enumeration date
02/05/2018
Last updated
02/05/2018
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