Daile M Jackson, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

033817-1 Issued in NY

Practice address

774 Fairmount Ave
Jamestown, NY 14701-2609

Phone

(716) 665-1166

Fax

(866) 902-1160

NPI assigned

Jul 13, 2011

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

Other identifiers 1

Other names 1

• Daile M Johnson Former name

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Health Aquatic Wellness of Chautauqua Physical Therapy PLLCGroup PAC ID 3971999814, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Health Aquatic Wellness of Chautauqua Physical Therapy PLLC

  • Physical Therapist
  • Fluvanna, NY
  • NPI 1144980962
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1310515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643500800000",
    "number": "1306134267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3266 FLUVANNA AVENUE EXT",
            "city": "FLUVANNA",
            "state": "NY",
            "postal_code": "147019706",
            "telephone_number": "716-665-0773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "774 FAIRMOUNT AVE",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147012609",
            "telephone_number": "716-665-1166",
            "fax_number": "866-902-1160"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3266 Fluvanna Avenue Ext",
            "address_purpose": "LOCATION",
            "city": "Fluvanna",
            "state": "NY",
            "postal_code": "147019706",
            "country_code": "US",
            "telephone_number": "716-665-0773",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DAILE",
        "middle_name": "M",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-13",
        "last_updated": "2022-01-30",
        "certification_date": "2022-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "033817-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03424691",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DAILE",
            "last_name": "JOHNSON",
            "middle_name": "M",
            "credential": "PT, DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kevin Matthew Intrieri, MD
• Katie Ireland
• Doreen Iula, GNP
• Seth Henry Iverson, MD
• Lewis James Ives III, RPH
• Todd Jacobson, M.D.
• Lisa Jaeckle
• Elizabeth R Jagoda, MS CCC SLP/L
• Ankur Jain, M.D.
• Jamestown Anesthesia Associates, PC

• Physical Therapist in Jamestown, NY
• Providers in Jamestown, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2022; 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.