Individual
DEBORAH ANN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1525 E MAIN ST, STREATOR, IL 61364-3162
(815) 672-4516
Mailing address
934 E WATER ST, PONTIAC, IL 61764-2149
(618) 267-0756
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
12/03/2021
Last updated
12/03/2021
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