Active NPI
Vanessa Marie Jackson, P.T.
- Physical Therapist
- San Diego, CA
National Provider Identifier
1376739615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 33954
- Practice address
- 11848 Bernardo Plaza Court #100
San Diego, CA 92128 - Phone
- (858) 217-2496
- Fax
- (888) 493-4898
- NPI assigned
- Sep 20, 2007
- Sex
- Female
- Sole proprietor
- No
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 | 33954 | CA | Primary |
Addresses
Primary practice location
11848 Bernardo Plaza Court #100
San Diego, CA 92128
Mailing address
11848 Bernardo Plaza Court #100
San Diego, CA 92128
Phone (858) 217-2496
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": "1190246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1368576000000",
"number": "1376739615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11848 BERNARDO PLAZA COURT #100",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92128",
"telephone_number": "858-217-2496",
"fax_number": "888-493-4898"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11848 BERNARDO PLAZA COURT #100",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92128",
"telephone_number": "858-217-2496",
"fax_number": "888-493-4898"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "VANESSA",
"middle_name": "MARIE",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-20",
"last_updated": "2013-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "33954",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.