Individual
CATHERINE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
765 NORTHUMBERLAND HWY, CALLAO, VA 22435-2206
(804) 529-5178
(804) 529-5179
Mailing address
PO BOX 197, CALLAO, VA 22435-0197
(804) 529-5178
(804) 529-5179
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
0019012293
VA
Other
Enumeration date
07/08/2014
Last updated
07/08/2014
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