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Individual

PHYLISS L JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCMT,HE

Contact information

Practice address
1 ADVENTIST HEALTH WAY, ROSEVILLE, CA 95661-3266
(916) 406-0177
Mailing address
2201 ARENA BLVD APT 7106, SACRAMENTO, CA 95834-7940
(916) 706-9892

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
80744
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
B4915041
CA
Enumeration date
02/27/2020
Last updated
02/27/2020
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