Jackalyn Nicole Peterson, DPT

Primary specialty

SpecialistTaxonomy code 174400000X

License

2305206191 Issued in VA

Practice address

9860 Fairfax Blvd
Suite 1
Fairfax, VA 22030-1737

Phone

(703) 383-1616

Fax

(703) 383-1166

NPI assigned

Sep 29, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC, VA2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Excel Rehabilitation PLLCGroup PAC ID 1355243734, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Excel Rehabilitation, PLLC

  • Specialist
  • Fairfax, VA
  • NPI 1922091032

  DC

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1254182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479081600000",
    "number": "1013241769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9860 FAIRFAX BLVD",
            "address_2": "SUITE 1",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220301737",
            "telephone_number": "703-383-1616",
            "fax_number": "703-383-1166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9860 FAIRFAX BLVD",
            "address_2": "SUITE 1",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220301737",
            "telephone_number": "703-383-1616",
            "fax_number": "703-383-1166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JACKALYN",
        "middle_name": "NICOLE",
        "name_prefix": "Miss",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-29",
        "last_updated": "2016-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "VA",
            "license": "2305206191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aria J Peters-Griffin
• Christine Peterson, DPT
• Cindy Sue Peterson, RN FIRST ASSIST,CNOR
• Delea Peterson, LCSW
• Eileen Peterson, CRNA
• Katrina Peterson
• Kye Peterson
• Michael Lloyd Petranek, DPM
• Summer Moriah Ruth Petrilli, BCBA
• Michelle Lucille Petrini, BCBA

• Specialist in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Specialist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.