Individual
LATOYA S JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
12 LONG GLEN CT, COLUMBIA, SC 29229-7742
(803) 747-1795
Mailing address
12 LONG GLEN CT, COLUMBIA, SC 29229-7742
(803) 747-1795
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2641
SC
Other
Enumeration date
02/07/2023
Last updated
02/07/2023
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