Action Jackson Physical Therapy, P.C.
Organization Active NPI Physical Therapist · Oakland, CA
NPI 1255700555 · NPPES record last updated Sep 17, 2015
Key facts
- NPI
- 1255700555
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT23897 (CA)
- Legal business name
- ACTION JACKSON PHYSICAL THERAPY, P.C.
- Practice address
- 2844 Summit St
Suite 106
Oakland, CA 94609-3637 - Phone
- (510) 763-3005
- NPI assigned
- Sep 17, 2015
- Organization subpart
- No
Authorized official
- Name
- Mr. Shane Loran Jackson, DPT
- Title
- Owner/Physical Therapist
- Phone
- (510) 292-5385
Practitioners 2
-
Shane Loran Jackson, DPT
-
Floyd Huen, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160921001835 | CA | Part B Supplier - Clinic/Group Practice | 8921395880 |
Receives reassigned benefits from 1 practitioner Practice locations: Oakland, CA |
National Provider Directory
Locations
2844 Summit St
Ste 106
Oakland, CA 94609
Phone (510) 763-3005
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | PT23897 | CA | Yes |
Addresses
Primary practice location
2844 Summit St
Suite 106
Oakland, CA 94609-3637
Mailing address
1005 Solano Ave
Apt. a
Albany, CA 94706-1617
Phone (510) 292-5385
Other providers in Oakland, CA
- Samantha Acosta-Huerta
- Christine E Acosta
- Mia Acosta
- Miranda Acosta
- Paul Acosta
- Active Health Center
- Walter P. Acuna
- Jamie Adair
- Adam Warren MD Inc, a Professional Corporation
- Ali Abdulkarim Adam
All providers in Oakland, CA · Physical Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 17, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.