Individual
MARY CHRISTINE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
4650 W. SWEETWATER AVE., GLENDALE, AZ 85304
(602) 347-2600
Mailing address
937 W CAMPUS DR, PHOENIX, AZ 85013-4017
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1480
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
558736
—
AZ
Enumeration date
04/13/2007
Last updated
07/08/2007
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