Individual
DAVID JACKSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
258 N RON MCNAIR BLVD, LAKE CITY, SC 29560-2462
(843) 374-6198
(843) 374-6180
Mailing address
258 N RON MCNAIR BLVD, LAKE CITY, SC 29560-2462
(843) 374-6198
(843) 374-6180
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1706
SC
Other
Enumeration date
04/01/2008
Last updated
04/01/2008
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