Individual
DONNA LIANNE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4035 MERCANTILE DR, SUITE 108, LAKE OSWEGO, OR 97035-2546
(503) 216-2788
Mailing address
11546 SW LAKEVIEW TER, TIGARD, OR 97223-7859
(503) 524-4249
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2081
OR
Other
Enumeration date
05/31/2007
Last updated
07/08/2007
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