Active NPI
Joseph Jackson, R.P.T.
- Physical Therapist
- Gardena, CA
National Provider Identifier
1235306143
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT5788
- Practice address
- 15640 S Normandie Ave
Gardena, CA 90247-4016 - Phone
- (310) 631-8703
- Fax
- (310) 763-0400
- NPI assigned
- May 9, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT5788 | CA | Primary |
Addresses
Primary practice location
15640 S Normandie Ave
Gardena, CA 90247-4016
Mailing address
1954 Atlantic Ave
Long Beach, CA 90806-5510
Phone (310) 631-8703
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5788 | CA | MD | Social Worker |
| PT5788 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210291200000",
"number": "1235306143",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1954 ATLANTIC AVE",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908065510",
"telephone_number": "310-631-8703",
"fax_number": "562-591-1422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15640 S NORMANDIE AVE",
"city": "GARDENA",
"state": "CA",
"postal_code": "902474016",
"telephone_number": "310-631-8703",
"fax_number": "310-763-0400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JOSEPH",
"name_prefix": "Mr.",
"credential": "R.P.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-09",
"last_updated": "2008-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT5788",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gardena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.