Individual
JACK MIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RKT
Contact information
Practice address
41 PARK CREEK DR, GREENVILLE, SC 29605-4270
(864) 299-1600
Mailing address
41 PARK CREEK DR, GREENVILLE, SC 29605-4270
Taxonomy
Speciality
Code
Description
License number
State
226300000X
Kinesiotherapist
Primary
1982
MS
Other
Enumeration date
09/28/2016
Last updated
09/28/2016
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