Individual
JOSHUA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
76 LOU GROZA BLVD, BEREA, OH 44017-1238
(732) 272-7869
Mailing address
76 LOU GROZA BLVD, BEREA, OH 44017-1238
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000053452
OH
Other
Enumeration date
06/15/2023
Last updated
06/15/2023
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