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Individual

GERALD MICHAEL JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
2100 E CALVADA BLVD, PAHRUMP, NV 89048-5805
(775) 727-7959
(775) 727-7960
Mailing address
2100 E CALVADA BLVD, PAHRUMP, NV 89048-5805
(775) 727-7959
(775) 727-7960

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0624
NV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1730221029
NV
Enumeration date
02/13/2007
Last updated
11/20/2019
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