NPI 1104091784

Elizabeth a Jackson, LICMASSAGETHERAPI

Practitioner Specialist Portland, ME

Practice location

Address: 94 Auburn St STE 106, Portland, ME 04103-2141
Phone: (207) 878-3003
Fax: (207) 878-3004
Mailing address: 94 Auburn St Suite 106, Portland, ME 04103-2141

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X Licence MT3127 (ME)

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Registry record

NPI: 1104091784
Entity type: Individual
Sex (as registered): Female
NPI issued: 24 Apr 2008
Record last updated: 8 Dec 2008

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.