Individual
TARA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
303 NORTH HURSTBOURNE PARKWAY, SUITE 200, LOUISVILLE, KY 40222
(502) 412-5847
Mailing address
6328 STATE ROUTE 283, SEBREE, KY 42455-9358
(270) 835-2192
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-A01032
KY
Other
Enumeration date
05/29/2014
Last updated
05/29/2014
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