Individual
MR. NILS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
32 CAMPUS DRIVE, MISSOULA, MT 59812
(406) 243-4753
Mailing address
325 PLEASANT STREET, CONCORD, NH 03301
(339) 440-0707
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4332
MT
Other
Enumeration date
09/05/2012
Last updated
09/05/2012
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