Individual
MRS. AMY ESTELLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
2111 RIVERWALK DR, MOORE, OK 73160-2700
(405) 793-7885
Mailing address
2111 RIVERWALK DR., MOORE, OK 73160
(405) 793-7885
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3496
OK
Other
Enumeration date
03/01/2012
Last updated
03/01/2012
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