Individual
JACKSON TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
863 N MAIN STREET EXT STE 200, WALLINGFORD, CT 06492-2434
(203) 265-3280
Mailing address
655 S WILLOW ST STE 128, MANCHESTER, NH 03103-5705
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12178
CT
225100000X
Physical Therapist
24093
MA
Other
Enumeration date
05/29/2019
Last updated
05/29/2019
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