Thea Elizabeth Jack, MPT,PCS

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

PT009479 Issued in GA

Practice address

10 Mall CT Ste B
Savannah, GA 31406-3691

Phone

(912) 713-0277

Fax

(888) 429-3741

NPI assigned

May 8, 2007

Last updated

Jul 31, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Pediatric Rehabilitation and Wellness LLC

  • Pediatric Physical Therapist
  • Savannah, GA
  • NPI 1669785580

  Pediatrics

  NPD Authorized official
• Developmental Therapy Associates

  • Rehabilitation Clinic/Center
  • Savannah, GA
  • NPI 1194054056
  NPD (past)

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

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596153600000",
    "number": "1336352079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 MALL CT STE B",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314063691",
            "telephone_number": "912-713-0277",
            "fax_number": "888-429-3741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 MALL CT STE B",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314063691",
            "telephone_number": "912-713-0277",
            "fax_number": "888-429-3741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "THEA",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "MPT,PCS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-08",
        "last_updated": "2020-07-31",
        "certification_date": "2020-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "GA",
            "license": "PT009479",
            "primary": true
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "NJ",
            "license": "QA01095200",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "739344620C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• J. Annette Parker-Herriott, O.D., P.C,. (EnVision Eye Care - Dr. J. A. Parker & Associates)
• J.C. Lewis Primary Healthcare Center, Inc
• J&L Anesthesia Inc
• Juha I Jaakkola, MD
• Jabez's Dream (Esther's House)
• Jackson P. Morgan, III, PC
• Kim Elizabeth Jackson-Allen, LPC,NCC,
• Alricka Jolynn Jackson, M.D.
• Alvin Deron Jackson, M.D.
• Calin Jackson, RBT

• Pediatric Physical Therapist in Savannah, GA
• Providers in Savannah, GA by specialty
• Pediatric Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 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.