Most Relevant Information
Provider Data
| NPI Number: | 1003673369 |
| Provider Name: | JACOB T JACKSON DPT |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | 1389882 |
Most Important Dates
| Enumeration Date: | 03/04/2024 |
| Last Updated: | 03/04/2024 |
Provider Practice Location
100 BOURLAND RD STE 170B
KELLER
TX
762483591
Practice Location Phone/Fax
| Phone: | 8004046050 |
| Fax: |
Provider Mailing Location
PO BOX 700688
SAN ANTONIO
TX
782700688
Provider Mailing Phone/Fax
| Phone: | 8004046050 |
| Fax: | 8663133397 |