Antonia Elizabeth Jacks, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

10214 Issued in SC

Practice address

1007 Grove Rd Ste C
Greenville, SC 29605-4630

Phone

(864) 233-5128

Fax

(864) 271-2599

NPI assigned

Jun 18, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Off the Block Physical Therapy

  • Physical Therapy Clinic/Center
  • Central, SC
  • NPI 1417537697
  NPD Authorized official

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

{
    "created_epoch": "1592438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592438400000",
    "number": "1285250084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 GROVE RD STE C",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054630",
            "telephone_number": "864-233-5128",
            "fax_number": "864-271-2599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 GROVE RD STE C",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054630",
            "telephone_number": "864-233-5128",
            "fax_number": "864-271-2599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKS",
        "first_name": "ANTONIA",
        "middle_name": "ELIZABETH",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-18",
        "last_updated": "2020-06-18",
        "certification_date": "2020-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "10214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Childress Ives
• Kristin Anne Ivester, RN
• Olivia Denise Jamison Ivey, OTR/L
• Melissa Ixcamey, M.D.
• J & J Safe Medical Transportation LLC
• Allison Giddings Jackson, M.D.
• Alyssa Jackson
• Amy Sue Jackson, RPH
• Ande M Jackson, MS,CNC
• Candace Smith Jackson, LPC

• Physical Therapist in Greenville, SC
• Providers in Greenville, SC by specialty
• Physical Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2020; 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.