Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | OH |
NPI | 1861581126 |
---|---|
Provider Name | James Hoyte Jackson |
First Address | Brecksville, OH 44141-3204 |
Second Address | Brecksville, OH 44141-3204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |