Individual
MRS. EMILY ROSE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2171 JERICHO TPKE STE 150, COMMACK, NY 11725-2947
(631) 600-1123
Mailing address
2171 JERICHO TPKE STE 150, COMMACK, NY 11725-2947
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
0858567
NY
Other
Enumeration date
06/01/2021
Last updated
06/01/2021
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