Individual
LAURA PERMELIA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.ED.,ATC, LAT
Contact information
Practice address
3300 AIRPORT ROAD, SOUTHERN PINES, NC 28387
(910) 692-6920
Mailing address
PO BOX 290, SOUTHERN PINES, NC 28388-0290
(910) 692-6920
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
002200
NY
2255A2300X
Athletic Trainer
Primary
AL3704
FL
Other
Enumeration date
08/01/2016
Last updated
08/01/2016
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