Active NPI
Bonnie Jean Jackson, PT
- Physical Therapist
- South Yarmouth, MA
National Provider Identifier
1033127592
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11679
- Practice address
- 23 Whites Path
Suite O2
South Yarmouth, MA 02664-1221 - Phone
- (508) 240-0024
- NPI assigned
- Aug 3, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 11679 | MA | Primary |
Addresses
Primary practice location
23 Whites Path
Suite O2
South Yarmouth, MA 02664-1221
Mailing address
16 Poplar LN
Brewster, MA 02631-2138
Phone (508) 240-0024
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1033127592",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16 POPLAR LN",
"city": "BREWSTER",
"state": "MA",
"postal_code": "026312138",
"telephone_number": "508-240-0024"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23 WHITES PATH",
"address_2": "SUITE O2",
"city": "SOUTH YARMOUTH",
"state": "MA",
"postal_code": "026641221",
"telephone_number": "508-240-0024"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "BONNIE",
"middle_name": "JEAN",
"name_prefix": "Miss",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "11679",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Yarmouth, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.