Individual
PIERCE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
204 CATHERINE ST, HARRISBURG, AR 72432-1100
(870) 578-0503
Mailing address
204 CATHERINE ST, HARRISBURG, AR 72432-1100
(870) 578-0503
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
4345
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4345
PTA LICENSE NUMBER
AR
Enumeration date
06/15/2022
Last updated
06/15/2022
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