Active NPI
Trent Jackman, PT
- Geriatric Physical Therapist
- Pocatello, ID
National Provider Identifier
1053503193
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Physical Therapist
- License
- PT-1236
- Practice address
- Garrison BLDG 63, Room 202
Stop 8045
Pocatello, ID 83209-0001 - Phone
- (208) 282-3065
- NPI assigned
- Aug 13, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Geriatric Physical Therapist | 2251G0304X | PT-1236 | ID | Primary |
Addresses
Primary practice location
Garrison BLDG 63, Room 202
Stop 8045
Pocatello, ID 83209-0001
Mailing address
Dept of Physical Therapy Idaho State University
Stop 8045
Pocatello, ID 83209-0001
Phone (208) 282-3065
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT-1236 | ID | MD | Geriatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186963200000",
"number": "1053503193",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "DEPT OF PHYSICAL THERAPY IDAHO STATE UNIVERSITY",
"address_2": "STOP 8045",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832090001",
"telephone_number": "208-282-3065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "GARRISON BLDG 63, ROOM 202",
"address_2": "STOP 8045",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832090001",
"telephone_number": "208-282-3065"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKMAN",
"first_name": "TRENT",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-13",
"last_updated": "2007-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "2251G0304X",
"taxonomy_group": "",
"desc": "Physical Therapist, Geriatrics",
"state": "ID",
"license": "PT-1236",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 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.