Individual
MR. KELLY JAMES JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1424 E FOREMASTER DR, SUITE 130, SAINT GEORGE, UT 84790-5832
(435) 251-2367
Mailing address
1819 S 2780 E, SAINT GEORGE, UT 84790-7166
(435) 669-5892
(435) 251-2366
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
347889-2401
UT
Other
Enumeration date
06/12/2007
Last updated
05/15/2010
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