Austin Jacob Jackson, PT., DPT.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2017029489 Issued in MO

Practice address

8755 S Harlem Ave
Bridgeview, IL 60455

Phone

(708) 430-2295

NPI assigned

Aug 28, 2017

Last updated

Aug 28, 2017By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1503878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503878400000",
    "number": "1194242388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8755 S HARLEM AVE",
            "city": "BRIDGEVIEW",
            "state": "IL",
            "postal_code": "60455",
            "telephone_number": "708-430-2295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8755 S HARLEM AVE",
            "city": "BRIDGEVIEW",
            "state": "IL",
            "postal_code": "60455",
            "telephone_number": "708-430-2295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "AUSTIN",
        "middle_name": "JACOB",
        "name_prefix": "Mr.",
        "credential": "PT., DPT.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-28",
        "last_updated": "2017-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2017029489",
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MO",
            "license": "2017029489",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mia Iliopoulos, MM, MT-BC, CDP
• International Dental of Bridgeview LLC
• Omran Abdelaziz Ismail, P.T
• Naimeh K Issa, DMD
• Manar Jaber
• Mithila Janakiram, MD
• John F Torphy DDS PC
• Frederick John Kahle, O.D.
• Mohamed Karim, PT
• Hassen Kasem

• Physical Therapist in Bridgeview, IL
• Providers in Bridgeview, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2017; 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.