Individual
CHARLES LEE JACKSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2250 E FLAMINGO RD, LAS VEGAS, NV 89119-5170
(702) 784-4303
(702) 892-0237
Mailing address
2905 PORTADA AVE, HENDERSON, NV 89074-2845
(702) 635-6033
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2012
NV
Other
Enumeration date
05/26/2011
Last updated
05/26/2011
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