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Individual

MISTY MARIE JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
48 TARN TER, FROSTBURG, MD 21532-1242
(301) 689-1391
Mailing address
57 JACKSON ST, LONACONING, MD 21539-1307
(240) 609-9594

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A5057
MD

Other

Enumeration date
01/12/2024
Last updated
01/12/2024
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