Jackson Tobin Cavanaugh, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

CP022613T Issued in NC

Practice address

2555 Court Dr Ste 400
Gastonia, NC 28054-2180

Phone

(704) 864-5550

Fax

(704) 864-5550

NPI assigned

Aug 24, 2021

Last updated

Dec 16, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN, NC2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Fox Rehab PT NC LLCGroup PAC ID 5597113811, 39 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fox Rehab PT NC LLC

  • Physical Therapist
  • Matthews, NC
  • NPI 1053199844
  Medicare reassignment Care Compare group NPD
• Creative Health Care Management LLC

  dba Vertis Therapy

  • Physical Therapist
  • Fishers, IN
  • NPI 1902350457
  Medicare reassignment NPD
• Creative Health Care Management LLC

  dba Vertis Therapy

  • Physical Therapist
  • Kansas City, KS
  • NPI 1033866975
  NPD

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

{
    "created_epoch": "1629763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734307200000",
    "number": "1306513841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2555 COURT DR STE 400",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280542180",
            "telephone_number": "704-864-5550",
            "fax_number": "704-864-5550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2555 COURT DR STE 400",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280542180",
            "telephone_number": "704-864-5550",
            "fax_number": "704-864-5550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAVANAUGH",
        "first_name": "JACKSON",
        "middle_name": "TOBIN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-24",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05014254A",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "CP022613T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.13.34.110.1.998.01",
            "affiliationName": "Fox Rehab PT NC LLC",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2008 Moore Rd",
            "city": "Matthews",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281054978",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Catawba Creek Dental
• Victoria M Caudill, NP
• Kathryn Ann Caulfield, MD
• Walter Harry Caulfield III, MD
• Bailey Janean Cavanaugh, PA
• Collytte Diana Cederstrom
• Austin Cehelsky, PHARMD
• Teodor C Cenadic, DPT
• Center for Emotional Health
• Center for Vein Restoration NC PLLC

• Physical Therapist in Gastonia, NC
• Providers in Gastonia, 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 Dec 16, 2024; 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.