Individual
JONATHAN MARK JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1000 3RD ST, TILLAMOOK, OR 97141-3430
(503) 842-4444
Mailing address
1000 3RD ST, TILLAMOOK, OR 97141-3430
(503) 842-4444
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
60682
OR
225100000X
Physical Therapist
PT-2974
ID
225100000X
Physical Therapist
PT35976
CA
Other
Enumeration date
11/05/2009
Last updated
09/10/2014
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