Individual
KRISTEN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3248 LITHIA PINECREST RD STE 102, VALRICO, FL 33596-5682
(813) 662-1366
Mailing address
3248 LITHIA PINECREST RD STE 102, VALRICO, FL 33596-5682
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA25124
FL
Other
Enumeration date
08/13/2014
Last updated
08/13/2014
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