Vivian Sapphira Jackson

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P24685 Issued in NC

Practice address

1602 S Stratford Rd Ste 130
Winston Salem, NC 27103-2959

Phone

(336) 281-2045

NPI assigned

Feb 24, 2026

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Independent Physical Therapy of Georgia, LLCGroup PAC ID 2961312244, 526 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Independent Physical Therapy of Georgia, LLC

  • Physical Therapist
  • Fort Oglethorpe, GA
  • NPI 1780636068
  Medicare reassignment Care Compare group
• Agilitas USA Inc

  • Physical Therapy Clinic/Center
  • Hixson, TN
  • NPI 1962417444

  GA

  Medicare reassignment
• Benchmark Physical Therapy, Inc

  • Physical Therapy Clinic/Center
  • Duluth, GA
  • NPI 1083666903
  Medicare reassignment
• Activcare Physical Therapy, LLC

  • Clinic/Center
  • Raleigh, NC
  • NPI 1548409626

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1771891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785283200000",
    "number": "1285588673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 YORK RD STE 300",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1602 S STRATFORD RD STE 130",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271032959",
            "telephone_number": "336-281-2045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "VIVIAN",
        "middle_name": "SAPPHIRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-02-24",
        "last_updated": "2026-07-29",
        "certification_date": "2026-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P24685",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "CP053417T",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Staci Tate Jackson, SLP
• Teresa B. Jackson, RPH.
• Tommie S. Jackson
• Toni Beth Jackson, PA-C
• Travis Harold Jackson, MD
• Jacob Brotzman DMD PLLC
• Jose Guadalupe Jacobo Pacheco
• Garcia Jacobs Harris
• Bradley Edgar Jacobs, MD
• Kimura Garcia Chermez'S Jacobs, PA-C

• Physical Therapist in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.