Individual
DESHAUN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
709 OLIVIA DR, DAVISON, MI 48423-1248
(810) 449-8321
Mailing address
709 OLIVIA DR, DAVISON, MI 48423-1248
(810) 449-8321
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502004671
MI
Other
Enumeration date
04/04/2017
Last updated
04/04/2017
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