IDA DESIREE JACKSON
Individual Provider (NPI-1)
Active
Physical Therapy Assistant
Provider Information
- NPI Number
1639957434- Provider Type
- Individual Provider (NPI-1)
- Status
- Active
Contact & Location
- Address
- 291 PLANTATION CENTRE DR N APT 705, MACON, GA, 312109249
- Phone
- (478) 447-7052
Specialties & Taxonomies
Physical Therapy Assistant
Primary License: GA #PTA002042