Individual
JILLYN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1256 E 1300 S, SALT LAKE CITY, UT 84105-1949
(801) 641-2494
Mailing address
1256 E 1300 S, SALT LAKE CITY, UT 84105-1949
(801) 641-2494
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
284914-2402
UT
Other
Enumeration date
04/07/2017
Last updated
04/07/2017
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