Individual
REBECCA JO JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
735 N FOREMAN ST, VINITA, OK 74301-1422
(918) 256-9207
(918) 256-9209
Mailing address
6600 S YALE AVE STE 500, TULSA, OK 74136-3319
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2710
OK
Other
Enumeration date
03/24/2021
Last updated
03/24/2021
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