Individual
TONI M. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NCTMB
Contact information
Practice address
4806 STATE ST, HOME OFFICE, EAST SAINT LOUIS, IL 62205-1355
(618) 225-2777
Mailing address
4806 STATE ST, HOME OFFICE, EAST SAINT LOUIS, IL 62205-1355
(618) 271-6247
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
225400000X
Rehabilitation Practitioner
—
—
225700000X
Massage Therapist
Primary
2005015267
MO
226000000X
Recreational Therapist Assistant
—
—
226300000X
Kinesiotherapist
—
—
Other
Enumeration date
12/07/2009
Last updated
02/25/2021
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