NPI 1003415464

Kim B Jackson

Practitioner Massage Therapist Glen Cove, NY

Practice location

Address: 29 Glen Cove Ave STE 212, Glen Cove, NY 11542-2831
Phone: (516) 384-7670
Mailing address: 1360 C St, Elmont, NY 11003-3816

Registered specialties

Massage Therapist Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225700000X Licence 028858 (NY)

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Registry record

NPI: 1003415464
Entity type: Individual
Sex (as registered): Female
NPI issued: 18 Oct 2020
Record last updated: 18 Oct 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.