Individual
JACOB LANE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
401 N COLLEGE RD STE 1B, LAFAYETTE, LA 70506-4263
(337) 993-2766
Mailing address
983A E LANCASTER AVE, DOWNINGTOWN, PA 19335-3184
(337) 993-2766
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11757
LA
Other
Enumeration date
05/30/2024
Last updated
05/30/2024
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