Brandi Jackson, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

2572 E South Weber Dr Ste 5
South Weber, UT 84405-9550

Phone

(801) 479-7045

NPI assigned

Mar 15, 2019

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

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Orthopaedic and Neurological Rehab Inc

  • Rehabilitation Clinic/Center
  • Billings, MT
  • NPI 1225496540

  Physical Therapist, UT

  Medicare reassignment NPD
• Orthopaedic and Neurological Rehabilitation, Speech Pathology, Inc

  • Rehabilitation Clinic/Center
  • Tustin, CA
  • NPI 1548940885
  NPD
• Mountain Land Rehabilitation LLC

  • Physical Therapist
  • Salt Lake City, UT
  • NPI 1265549372
  NPD (past)

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

{
    "created_epoch": "1552608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552608000000",
    "number": "1316406747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 711185",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841711185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2572 E SOUTH WEBER DR STE 5",
            "city": "SOUTH WEBER",
            "state": "UT",
            "postal_code": "844059550",
            "telephone_number": "801-479-7045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BRANDI",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-15",
        "last_updated": "2019-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "11189504-2401",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lyle Biddle Jr., P.T.
• BX Redirect
• Annemarie Christopulos
• Roxanne Hastings, RBT
• John William Henderson, ATC
• Diana L Lewis, L.M.T.
• Richard Thomas Mackay, CMHC
• Mountain Region Home Medical
• My Home Medical LLC
• Petersen Farms Assisted Living & Memory Care

• Physical Therapist in South Weber, UT
• Providers in South Weber, UT by specialty
• Physical Therapist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2019; 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.