Individual
JEFFREY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 N MAIN ST STE C, SAND SPRINGS, OK 74063-7638
(918) 245-0111
Mailing address
PO BOX 721018, NORMAN, OK 73070-4786
(405) 809-8713
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5484
OK
Other
Enumeration date
08/08/2019
Last updated
12/07/2021
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