Kathleen M. Jackson, PHYSICAL THERAPIST

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305004353 Issued in VA

Practice address

40 North Hill Dr
Warrenton, VA 20186-2610

Phone

(540) 341-1922

Fax

(540) 341-1923

NPI assigned

Jun 5, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Blaser Physical Therapy

  • Physical Therapist
  • Warrenton, VA
  • NPI 1205895711
  NPD (past)

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

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195603200000",
    "number": "1174725642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 NORTH HILL DR",
            "city": "WARRENTON",
            "state": "VA",
            "postal_code": "201862610",
            "telephone_number": "540-341-1922",
            "fax_number": "540-341-1923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 NORTH HILL DR",
            "city": "WARRENTON",
            "state": "VA",
            "postal_code": "201862610",
            "telephone_number": "540-341-1922",
            "fax_number": "540-341-1923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KATHLEEN",
        "middle_name": "M.",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-05",
        "last_updated": "2007-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305004353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "194042",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• I'M Still Me, LLC
• Wasama Idlibi, PA-C
• In Luck Counseling LLC
• Innovative Physical Therapy LLC
• Alyssa Jabar
• Patrice Lynette Jackson, LPC
• Lauren Cassis Jacques, P.A.-C
• Amna Nasar Jadali, PAC
• Jaffe Psychological Services LLC
• James W Jelinek DDS & Susan a Yung DDS P C

• Physical Therapist in Warrenton, VA
• Providers in Warrenton, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 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.

Verify at the official NPI Registry.