Individual
BREANNA S JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
355 N MAIN ST STE 103, KANAB, UT 84741-3260
(435) 644-4199
Mailing address
608 E CEDAR CIR, KANAB, UT 84741-3837
(435) 851-1283
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
10195848-2402
UT
Other
Enumeration date
10/04/2023
Last updated
10/04/2023
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