Individual
ANTONIA ELIZABETH JACKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
1007 GROVE RD STE C, GREENVILLE, SC 29605-4630
(864) 233-5128
(864) 271-2599
Mailing address
1007 GROVE RD STE C, GREENVILLE, SC 29605-4630
(864) 233-5128
(864) 271-2599
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10214
SC
Other
Enumeration date
06/18/2020
Last updated
06/18/2020
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