Individual
MATTHEW JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
9241 UNIVERSITY BLVD, NORTH CHARLESTON, SC 29406-9349
(843) 414-1140
(843) 553-2946
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
24109
MD
Other
Enumeration date
07/24/2012
Last updated
11/16/2015
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