Active NPI
Courtney Marie Jackson
- Physical Therapist
- Albuquerque, NM
National Provider Identifier
1235658998
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PTL.0015107
- Practice address
- 9150 McMahon Blvd NW
Albuquerque, NM 87114-5201 - Phone
- (816) 262-7124
- NPI assigned
- Sep 13, 2017
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PTL.0015107 | CO | Primary |
Addresses
Primary practice location
9150 McMahon Blvd NW
Albuquerque, NM 87114-5201
Mailing address
16002 County Road 311
Savannah, MO 64485-2234
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 |
|---|---|---|---|
| PTL.0015107 | CO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1505260800000",
"number": "1235658998",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16002 COUNTY ROAD 311",
"city": "SAVANNAH",
"state": "MO",
"postal_code": "644852234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9150 MCMAHON BLVD NW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871145201",
"telephone_number": "816-262-7124"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "COURTNEY",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-13",
"last_updated": "2017-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CO",
"license": "PTL.0015107",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 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.