Individual
EBONIE NICOLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1045 BROADWAY PARK STE 107, HOMEWOOD, AL 35209-6256
(205) 573-6278
(205) 573-6280
Mailing address
6397 LEE HWY STE 300, CHATTANOOGA, TN 37421-4915
(423) 238-7217
(423) 238-3473
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA9250
AL
Other
Enumeration date
01/25/2019
Last updated
01/25/2019
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