Individual
GINA M JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
716 E BELLA VISTA ST, LAKELAND, FL 33805-3009
(863) 683-6504
Mailing address
716 E BELLA VISTA ST, LAKELAND, FL 33805-3009
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA27269
FL
Other
Enumeration date
07/27/2023
Last updated
07/27/2023
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