Individual
CORTEZ JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4109 HIGHWAY 98 W, SUMMIT, MS 39666-9132
(601) 276-3909
Mailing address
133 W GALLATIN ST, HAZLEHURST, MS 39083-3020
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA4646
MS
Other
Enumeration date
04/30/2010
Last updated
04/30/2010
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