Individual
PHYLISS L JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMT,HE
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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