| Doctor Name: | MR. KELLY JAMES JACKSON |
| NPI Number: | 1811191166 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | 347889-2401 |
| Business Practice Address: | 1424 E Foremaster Dr Suite 130 Saint George, UT - 847905832 |
| Business Phone Number: | 4352512367 |
| Business Fax Number: | |
| Mailing Address: | 1819 S 2780 E, SAINT GEORGE |
| State: | UT |
| Postal Code: | 847907166 |
| Phone Number: | 4356695892 |
| Fax Number: | 4352512366 |
| NPI Enumeration Date: | 06/12/2007 |
| NPI Last Update Date: | 05/15/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 347889-2401 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |