Individual
THERESA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3647 CEDAR AVE S, MINNEAPOLIS, MN 55407-2919
(612) 728-0223
Mailing address
10820 S SHORE DR APT 13, PLYMOUTH, MN 55441-4970
(612) 242-9536
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
10/12/2018
Last updated
10/12/2018
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