Individual
JACKSON EVERSOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3200 NORTHLINE AVE, SUITE 160, GREENSBORO, NC 27408-7616
(336) 545-3534
Mailing address
126 COLTSGATE DR, KERNERSVILLE, NC 27284-6350
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A5536
NC
Other
Enumeration date
01/26/2017
Last updated
01/26/2017
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