Individual
DR. JACKSON GEORGE MATUELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
625 N 144TH AVE STE 102, OMAHA, NE 68154-1935
(402) 934-8688
Mailing address
625 N 144TH AVE STE 102, OMAHA, NE 68154-1935
(402) 934-8688
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4212
NE
Other
Enumeration date
06/11/2021
Last updated
06/11/2021
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