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Individual

CORRINE R JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMT

Contact information

Practice address
40 N FOREST RD, BUFFALO, NY 14221-5230
(716) 235-1338
Mailing address
23 NEW SOUTHGATE RD LOWR, BUFFALO, NY 14215-1809
(716) 310-4070

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
030743
NY

Other

Enumeration date
09/06/2023
Last updated
05/08/2025
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