Individual
BIRDLEE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4012 MORNING GLORY LN, PLANO, TX 75093-7549
(972) 422-2600
Mailing address
4012 MORNING GLORY LN, PLANO, TX 75093-7549
(972) 422-2600
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT008849
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
225700000X
SPORTS MASSAGE THERAPIST
TN
Enumeration date
07/26/2016
Last updated
07/26/2016
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