IndividualActive
David Jackson Jr., PTA
NPI 1104098904 · Physical Therapy Assistant · Lake City, SC
Provider details
- NPI number
- 1104098904
- Entity type
- Individual
- Primary specialty
- Physical Therapy AssistantRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Credential
- PTA
- Sex
- Male
- Sole proprietor
- No
- License
- 1706 (SC)
Practice location
258 N Ron Mcnair Blvd
Lake City, SC 29560-2462
Phone: (843) 374-6198
Fax: (843) 374-6180
Mailing address
258 N Ron Mcnair Blvd
Lake City, SC 29560-2462
Registry dates
- Enumerated
- 2008-04-01
- Last updated
- 2008-04-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.