Individual
GABRIELLE ELYSE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1 MASONIC WAY, SULLIVAN, IL 61951-9467
(217) 728-3700
Mailing address
2128 E 1525 NORTH RD, SHELBYVILLE, IL 62565-4537
(217) 273-7930
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.007936
IL
Other
Enumeration date
06/09/2022
Last updated
06/09/2022
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