Individual
MARY COBBS JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1700 BUCKNER ST STE 150, SHREVEPORT, LA 71101-4407
(318) 218-1993
Mailing address
613 DUMAINE DRIVE, BOSSIER CITY, LA 71111
(318) 218-1993
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
07663
LA
Other
Enumeration date
12/12/2011
Last updated
09/16/2022
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