Individual
COREY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.T.
Contact information
Practice address
3460 N RIDGE RD STE 80, WICHITA, KS 67205-1223
(316) 202-0340
Mailing address
1650 LYNDON FARM CT STE 300, LOUISVILLE, KY 40223-5005
(316) 263-0003
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11-04877
KS
Other
Enumeration date
06/12/2014
Last updated
09/27/2023
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