Individual
RUSSELL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1551 N MAIN ST, PAYSON, UT 84651-5015
(801) 465-5400
(801) 465-4872
Mailing address
1952 E 7000 S, SALT LAKE CITY, UT 84121-6877
(801) 495-5227
(801) 495-5303
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
88900572401
UT
Other
Enumeration date
04/10/2014
Last updated
04/10/2014
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