Individual
MR. AUSTIN JACOB JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT., DPT.
Contact information
Practice address
8755 S HARLEM AVE, BRIDGEVIEW, IL 60455
(708) 430-2295
Mailing address
8755 S HARLEM AVE, BRIDGEVIEW, IL 60455
(708) 430-2295
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2017029489
MO
2251X0800X
Orthopedic Physical Therapist
2017029489
MO
Other
Enumeration date
08/28/2017
Last updated
08/28/2017
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