Individual
FREDERICK JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2244 BRINKER RD, DENTON, TX 76208-6120
(940) 320-6300
Mailing address
2007 TEASLEY LN APT 117, DENTON, TX 76205-8221
(972) 489-3620
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2139377
TX
Other
Enumeration date
08/27/2018
Last updated
08/27/2018
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