Individual
MS. ASHIYA FAYE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT, PCS
Contact information
Practice address
3205 FREEDOM DR, CHARLOTTE, NC 28208-2866
(704) 336-7100
Mailing address
2621 KEZIAH RD, MATTHEWS, NC 28105-1993
(773) 592-6873
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
070010961
IL
Other
Enumeration date
03/05/2007
Last updated
01/12/2022
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