Individual
MS. TIFFANY SHAUNTE' JACKSON-PONDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1136 N MILL ST, NAPERVILLE, IL 60563-3577
(630) 355-3300
Mailing address
1136 N MILL ST, NAPERVILLE, IL 60563-3577
(630) 355-3300
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.005716
IL
Other
Enumeration date
04/22/2012
Last updated
04/22/2012
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