Ethan Jacks, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

14-03380 Issued in KS

Practice address

9425 Mission Rd
Leawood, KS 66206-2045

Phone

(913) 381-2100

NPI assigned

Aug 23, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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 and National Provider Directory roles.

• Mpact Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Leawood, KS
  • NPI 1194265801
  NPD
• Preferred PT, LLC

  • Physical Therapy Clinic/Center
  • Leawood, KS
  • NPI 1437879590
  NPD

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

{
    "created_epoch": "1661212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1346969425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W DOUGLAS AVE STE 250",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672023002",
            "telephone_number": "316-263-0003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9425 MISSION RD",
            "city": "LEAWOOD",
            "state": "KS",
            "postal_code": "662062045",
            "telephone_number": "913-381-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKS",
        "first_name": "ETHAN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-23",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "KS",
            "license": "14-03380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Iron Horse Healthcare LLC
• Ironhorse Dental Group, LLC
• Ironwoods Behavioral Health LLC
• Ispin Health, LLC
• Nancy Israel, MD
• Scott Jackson, LPC
• James D Gentry DMD LLC
• Gerald Keith Jantz, M.D.
• Loretta A. Jasper, LCPC
• Diamond Jean Baptiste, FNP-C

• Physical Therapy Assistant in Leawood, KS
• Providers in Leawood, KS by specialty
• Physical Therapy Assistant in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2022; 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.