Zachary Bradley Jackson, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT5353 Issued in NM

Practice address

2205 S Main St
Las Cruces, NM 88005-3113

Phone

(575) 652-3515

Fax

(575) 652-3518

NPI assigned

Jun 20, 2018

Sex

Male

Sole proprietor

Yes

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)

Enrolled

State licenses

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

{
    "created_epoch": "1529452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536710400000",
    "number": "1205320405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 S MAIN ST",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880053113",
            "telephone_number": "575-652-3515",
            "fax_number": "575-652-3518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 S MAIN ST",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880053113",
            "telephone_number": "575-652-3515",
            "fax_number": "575-652-3518"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 W Ann Arbor Trl Ste 220",
            "address_purpose": "LOCATION",
            "city": "Plymouth",
            "state": "MI",
            "postal_code": "481706224",
            "country_code": "US",
            "telephone_number": "866-991-0900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ZACHARY",
        "middle_name": "BRADLEY",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-20",
        "last_updated": "2018-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305212070",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NM",
            "license": "PT5353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ike Ikponmwosa Iyamu, DNP, CRNA
• Menalyn Balancio Jabonete, PT/L
• Ernest Rhett Jabour
• Cisco Jackson
• Jessica Jackson
• Kendra Jacob, DPT
• Kent F Jacobs, MD
• Jacqueline Villalobos ND LLC
• Albert L Jacquez, LMSW
• Mandy Marie Jacquez, LCSW

• Physical Therapist in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Physical Therapist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2018; 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.