Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | IL |
NPI | 1073668810 |
---|---|
Provider Name | Ms. Ann Wilborn Jackson |
First Address | Flossmoor, IL 60422-1046 |
Second Address | Flossmoor, IL 60422-1046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 08/07/2007 |