Individual
KRISTIN BURCH JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT, DPT, CMTPT
Contact information
Practice address
317 WALLACE AVE STE 203, LOUISVILLE, KY 40207-3060
(502) 209-7677
Mailing address
4710 KITTY HAWK WAY, LOUISVILLE, KY 40207-1753
(859) 619-2349
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
004956
KY
Other
Enumeration date
10/21/2019
Last updated
12/09/2020
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