| NPI | 1891487179 |
|---|---|
| Former Name | PAYTON JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 6303) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2023-05-24 |
| Last Update Date | 2025-06-19 |