David Jackson Jr., PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

1706 Issued in SC

Practice address

258 N Ron McNair Blvd
Lake City, SC 29560-2462

Phone

(843) 374-6198

Fax

(843) 374-6180

NPI assigned

Apr 1, 2008

Last updated

Apr 1, 2008By the provider in NPPES

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1207008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207008000000",
    "number": "1104098904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "258 N RON MCNAIR BLVD",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295602462",
            "telephone_number": "843-374-6198",
            "fax_number": "843-374-6180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "258 N RON MCNAIR BLVD",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295602462",
            "telephone_number": "843-374-6198",
            "fax_number": "843-374-6180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON JR.",
        "first_name": "DAVID",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-01",
        "last_updated": "2008-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "SC",
            "license": "1706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hopehealth, Inc
• Hopehealth, Inc (HopeHealth Dental Lake City)
• T'Auna Hudson
• Ih3 Physcial Therapy (CPM Physical Therapy)
• Linda Teresa Jackosn
• Paul Wells James, DNP
• Kirby Rebekah Jeffords
• Carlon Darneil Jenkins, NP
• Sheriko Jernigan
• Bonita D Johnson, FNP

• Physical Therapy Assistant in Lake City, SC
• Providers in Lake City, SC by specialty
• Physical Therapy Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.