Individual
DENISE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
10300 SOUTHWEST HWY, CHICAGO RIDGE, IL 60415-1426
(708) 425-1100
(708) 425-0209
Mailing address
8342 S KENTON AVE, CHICAGO, IL 60652-3040
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160000679
IL
Other
Enumeration date
02/24/2012
Last updated
02/24/2012
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