Individual
KELLIE LYN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1980 SUNSET POINT RD, CLEARWATER, FL 33765-1132
(727) 443-1588
Mailing address
1980 SUNSET POINT RD, CLEARWATER, FL 33765-1132
(727) 443-1588
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA23154
FL
Other
Enumeration date
12/09/2010
Last updated
12/09/2012
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