Individual
ZACHARY BRADLEY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
2205 S MAIN ST, LAS CRUCES, NM 88005-3113
(575) 652-3515
(575) 652-3518
Mailing address
2205 S MAIN ST, LAS CRUCES, NM 88005-3113
(575) 652-3515
(575) 652-3518
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2305212070
VA
225100000X
Physical Therapist
Primary
PT5353
NM
Other
Enumeration date
06/20/2018
Last updated
09/12/2018
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