Individual
LESLEY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
60 BRIMLEY DR, FREDERICKSBURG, VA 22406-5148
(540) 479-3788
Mailing address
411 PARK COVE DR, STAFFORD, VA 22554-3716
(703) 595-5565
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306603225
VA
Other
Enumeration date
11/19/2012
Last updated
11/19/2012
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