Corey Jackson, D.P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

11-04877 Issued in KS

Practice address

3460 N Ridge Rd Ste 80
Wichita, KS 67205-1223

Phone

(316) 202-0340

NPI assigned

Jun 12, 2014

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

Other names 1

• Mr. Corey Jackson Professional name

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced PT LLCGroup PAC ID 3678524709, 84 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.

• Advanced PT LLC

  • Physical Therapist
  • Wichita, KS
  • NPI 1780616789
  Medicare reassignment Care Compare group NPD
• Advanced PT LLC

  • Physical Therapist
  • Kansas City, KS
  • NPI 1144251232
  NPD
• Advanced PT, LLC

  • Physical Therapist
  • Wichita, KS
  • NPI 1861873739
  NPD
• Via Christi Rehabilitation Hospital, Inc

  • Family Medicine Physician
  • Wichita, KS
  • NPI 1598001331

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1402531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695772800000",
    "number": "1154735611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 LYNDON FARM CT STE 300",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402235005",
            "telephone_number": "316-263-0003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3460 N RIDGE RD STE 80",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672051223",
            "telephone_number": "316-202-0340"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1551 N Rock Rd",
            "address_purpose": "LOCATION",
            "city": "Wichita",
            "state": "KS",
            "postal_code": "672061255",
            "country_code": "US",
            "telephone_number": "316-858-1885",
            "fax_number": "316-858-1892",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "COREY",
        "credential": "D.P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-12",
        "last_updated": "2023-09-27",
        "certification_date": "2023-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": "11-04877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COREY",
            "last_name": "JACKSON",
            "prefix": "MR.",
            "credential": "D.P.T.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Lisa Jack
• Alexandra Maynard Jackson, CCC-SLP
• Chaikeely Jackson
• Chelsea M Jackson, LMSW
• Chelsie Jackson, RDN
• Hannah Isabelle Piros Jackson, LMLP
• Matthew DV Jackson, DDS
• Megan J Jackson, RN
• Renee Jackson, RN, BSN
• Shawn Ian Jackson, MD

• Physical Therapist in Wichita, KS
• Providers in Wichita, KS by specialty
• Physical Therapist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2023; 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.