Individual
MS. LORIE G JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1800 BLUEGRASS AVE, LOUISVILLE, KY 40215-1130
(502) 361-2301
Mailing address
106 ADA AVE, SHELBYVILLE, KY 40065-1432
(502) 257-2497
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A02653
KY
Other
Enumeration date
03/13/2015
Last updated
03/13/2015
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