Individual
MATTHEW HOLST JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1515 N CENTER ST STE 5, LONOKE, AR 72086-2100
(501) 676-5540
(501) 676-6499
Mailing address
PO BOX 5718, KALISPELL, MT 59903-5718
(406) 756-0134
(406) 300-1612
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1452
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127082721
—
AR
Enumeration date
01/26/2006
Last updated
11/23/2021
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