Doctor Name: | TONI M. JACKSON |
NPI Number: | 1376871103 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NCTMB |
License Number: | 2005015267 |
Business Practice Address: | 4806 State St Home Office East Saint Louis, IL - 622051355 |
Business Phone Number: | 6182716247 |
Business Fax Number: | |
Mailing Address: | 4806 State St, Home Office EAST SAINT LOUIS |
State: | IL |
Postal Code: | 622051355 |
Phone Number: | 6182716247 |
Fax Number: | |
NPI Enumeration Date: | 12/07/2009 |
NPI Last Update Date: | 04/10/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 2005015267 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |