Corey E Jackson

NPI 1558672881 - Physical Therapist - 225100000X

NPI Details
NPI 1558672881
Gender Male
Enumeration Date 07/01/2010
Last Updated 07/01/2010
Entity Type Individual
Active Over 6 years ago
Practice Location
917 BEVILLE RD
SUITE G
SOUTH DAYTONA FL, 32119-1712, US
Phone (386) 756-4395
Fax (866) 426-2811
Business Location
11 BARN HILL RD
BLOOMFIELD CT, 06002-1238, US
Phone (386) 756-4395
Fax (866) 426-2811
Toxanomy
Taxonomy Code 225100000X
License State Massachusetts
License Number 19079
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According to our database, Corey E Jackson NPI is 1558672881, taxonomy code is 225100000X and license number is 19079, license state is located at Massachusetts. Corey E Jackson physically located at 917 Beville Rd, South Daytona FL, 32119-1712. NPI Number Corey E Jackson has the Individual type.

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1558672881 NPI number is provided on an as is basis without warranty of any kind. 1558672881 is maintained by the National Plan & Provider Enumeration System. The contents of Corey E Jackson are for informational purposes only.