Active NPI
Dianne Ruth Jackson, PT
- Orthopedic Physical Therapist
- Charlotte, NC
National Provider Identifier
1255314787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- 4275
- Practice address
- 1001 Blythe Blvd
Suite 200
Charlotte, NC 28203-5863 - Phone
- (704) 323-2000
- NPI assigned
- Nov 29, 2005
- 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 |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | 4275 | NC | Primary |
Addresses
Primary practice location
1001 Blythe Blvd
Suite 200
Charlotte, NC 28203-5863
Mailing address
4601 Park Rd
Suite 300
Charlotte, NC 28209-3239
Phone (704) 323-2000
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 |
|---|---|---|---|
| 4275 | NC | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1273708800000",
"number": "1255314787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4601 PARK RD",
"address_2": "SUITE 300",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282093239",
"telephone_number": "704-323-2000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 BLYTHE BLVD",
"address_2": "SUITE 200",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282035863",
"telephone_number": "704-323-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DIANNE",
"middle_name": "RUTH",
"name_prefix": "Ms.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-29",
"last_updated": "2010-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "NC",
"license": "4275",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.