Individual
GREGORY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
9685 CHILLICOTHE RD, KIRTLAND, OH 44094-8503
(440) 256-8100
Mailing address
9685 CHILLICOTHE RD, KIRTLAND, OH 44094-8503
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
08890
OH
Other
Enumeration date
06/23/2016
Last updated
06/23/2016
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