Jaclyn McCullough, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P20288 Issued in NC

Practice address

1128 Ny-17K
Suite 3
Montgomery, NY 12549-1254

Phone

(845) 769-7777

Fax

(845) 769-0007

NPI assigned

Apr 27, 2021

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 names 1

• Jaclyn Feffer Former name

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Resolve Physical Therapy, P. C.Group PAC ID 3678985595, 7 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.

• Resolve Physical Therapy, P. C.

  • Physical Therapist
  • Montgomery, NY
  • NPI 1649886201
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1619481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678233600000",
    "number": "1346822426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1128 STATE ROUTE 17K STE 3",
            "city": "MONTGOMERY",
            "state": "NY",
            "postal_code": "125492270",
            "telephone_number": "845-769-7777",
            "fax_number": "845-769-0007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1128 NY-17K",
            "address_2": "SUITE 3",
            "city": "MONTGOMERY",
            "state": "NY",
            "postal_code": "125491254",
            "telephone_number": "845-769-7777",
            "fax_number": "845-769-0007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "JACLYN",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-27",
        "last_updated": "2023-03-08",
        "certification_date": "2023-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P20288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "FEFFER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kathy A Manning, RN
• Jessica Rose Markman, M.S. CCC-SLP, TSSLD
• Sophia Marrero, LCAT
• Jordan Marron, LMSW
• Brianna Mathelier
• Emily C McDonald, MSPT
• David McEvoy, OTR
• Janice McGrath, MA. CCC. SLP
• Gregory Thomas McMahon, D.D.S.
• Robert A McPhillips

• Physical Therapist in Montgomery, NY
• Providers in Montgomery, 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 Mar 8, 2023; 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.