| NPI | 1255700555 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE LORAN JACKSON Owner/Physical Therapist 510-292-5385 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT23897) |
| Enumeration Date | 2015-09-17 |
| Last Update Date | 2015-09-17 |