Individual
ANNIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1525 INTERNATIONAL PKWY, HEATHROW, FL 32746-7644
(800) 798-6035
Mailing address
1525 INTERNATIONAL PKWY, HEATHROW, FL 32746-7644
(800) 798-6035
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3844
OK
Other
Enumeration date
01/19/2012
Last updated
01/19/2012
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