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Individual

KELLI TRACY JACKMAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MPT

Contact information

Practice address
981 DOWLING BLVD, SAN LEANDRO, CA 94577-2125
(510) 638-9618
Mailing address
981 DOWLING BLVD, SAN LEANDRO, CA 94577-2125
(510) 638-9618

Taxonomy

Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT 28294
CA

Other

Enumeration date
09/08/2010
Last updated
09/08/2010
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