| NPI | 1629289301 |
|---|---|
| Former Name | REBECCA LYNNE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 04502) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00008445) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2014-02-18 |