Individual
DONICA CHIVON JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPTA
Contact information
Practice address
11900 JESSICA LN, RAYTOWN, MO 64138-2649
(816) 743-0085
Mailing address
1624 WOODLAND BLVD, KANSAS CITY, KS 66106-2842
(913) 406-3044
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2006017162
MO
Other
Enumeration date
05/07/2013
Last updated
05/07/2013
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