Ebonie Nicole Jackson, PTA

NPI #1710441522 in Homewood, Alabama

Provider Information

NPI Number: 1710441522
Entity Type: Individual
Name: Ebonie Nicole Jackson, PTA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapy Assistant
Credential: PTA
Enumeration Date: Jan 25, 2019
Last Updated: Jan 25, 2019

Practice Location

Address: 1045 BROADWAY PARK STE 107
City: Homewood
State: Alabama
ZIP Code: 35209-6256
Phone: (205) 573-6278

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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