Active NPI
Ashiya Faye Jackson, DPT, PCS
- Pediatric Physical Therapist
- Charlotte, NC
National Provider Identifier
1164551826
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 070010961
- Practice address
- 3205 Freedom Dr
Charlotte, NC 28208-2866 - Phone
- (704) 336-7100
- NPI assigned
- Mar 5, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 070010961 | IL | Primary |
Addresses
Primary practice location
3205 Freedom Dr
Charlotte, NC 28208-2866
Mailing address
2621 Keziah Rd
Matthews, NC 28105-1993
Phone (773) 592-6873
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070010961 | IL | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641945600000",
"number": "1164551826",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2621 KEZIAH RD",
"city": "MATTHEWS",
"state": "NC",
"postal_code": "281051993",
"telephone_number": "773-592-6873"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3205 FREEDOM DR",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282082866",
"telephone_number": "704-336-7100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ASHIYA",
"middle_name": "FAYE",
"name_prefix": "Ms.",
"credential": "DPT, PCS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-05",
"last_updated": "2022-01-12",
"certification_date": "2022-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "IL",
"license": "070010961",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.