Individual
KATHLEEN GRACE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
590 S WAKARA WAY, SALT LAKE CITY, UT 84108-1200
(801) 587-7109
Mailing address
2927 E 3300 S, SALT LAKE CITY, UT 84109-2138
Taxonomy
Speciality
Code
Description
License number
State
2251N0400X
Neurology Physical Therapist
9047266-2401
UT
2251X0800X
Orthopedic Physical Therapist
Primary
9047266-2401
UT
Other
Enumeration date
07/27/2014
Last updated
07/27/2014
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