Individual
EMMANUEL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1561 POTOMAC GREENS DR STE 1A, ALEXANDRIA, VA 22314-6255
(703) 717-7667
Mailing address
1150 N FAYETTE ST APT 2517, ALEXANDRIA, VA 22314-2386
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305216707
VA
Other
Enumeration date
08/22/2024
Last updated
08/22/2024
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