Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 9274 | CO |
N | 2251X0800X | Physical Therapist - Orthopedic | 9274 | CO |
NPI | 1063618627 |
---|---|
Provider Name | Jackson Andrew Mcallister |
First Address | Aurora, CO 80012-5689 |
Second Address | Aurora, CO 80012-5689 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2007 |
Last Update Date | 19/05/2021 |