Active NPI
Damien S Jackson-Ricketts, PT, DPT
- Physical Therapist
- Venice, CA
National Provider Identifier
1346765195
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 293358
- Practice address
- 904 Palms Blvd
Venice, CA 90291-3853 - Phone
- (276) 768-7816
- NPI assigned
- Aug 12, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 293358 | CA | Primary |
Addresses
Primary practice location
904 Palms Blvd
Venice, CA 90291-3853
Mailing address
904 Palms Blvd
Venice, CA 90291-3853
Phone (276) 768-7816
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 293358 | Other | CA | PHYSICAL THERAPY LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613088000000",
"number": "1346765195",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "904 PALMS BLVD",
"city": "VENICE",
"state": "CA",
"postal_code": "902913853",
"telephone_number": "276-768-7816"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "904 PALMS BLVD",
"city": "VENICE",
"state": "CA",
"postal_code": "902913853",
"telephone_number": "276-768-7816"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON-RICKETTS",
"first_name": "DAMIEN",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "PT, DPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-08-12",
"last_updated": "2021-02-12",
"certification_date": "2021-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "293358",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICAL THERAPY LICENSE NUMBER",
"identifier": "293358",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Venice, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.