| NPI | 1285647768 |
|---|---|
| Former Name | LINDA A JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 1096) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 00008303) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2007-07-08 |