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1811511199
SAMUEL COLLINS JACKSON
MT PLEASANT, SC
NPI
1811511199
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225100000X Physical Therapist
(Licence: SC 10222)
Additional Taxonomies
225100000X Physical Therapist
Enumeration Date
2020-06-03
Last Update Date
2022-10-20
Business Address
SAMUEL COLLINS JACKSON DPT
1125 LANDAU LN
MT PLEASANT, SC 29466-7300
Phone number: 843-375-5448
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Mailing Address
SAMUEL COLLINS JACKSON DPT
5111 N RHETT AVE
NORTH CHARLESTON, SC 29405-4219
Phone number: 843-804-9478
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