Individual
CASEY MATTEA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1450 AVIATION DR STE 201, HAILEY, ID 83333-8785
(208) 727-8281
Mailing address
206 W BULLION ST, HAILEY, ID 83333-8506
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1371587
ID
Other
Enumeration date
12/01/2025
Last updated
12/01/2025
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