Chasity Renea Jackson-Ellis, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

07075 Issued in LA

Practice address

423 Treeline Park Ste 201
San Antonio, TX 78209-2078

Phone

(210) 602-0235

NPI assigned

Jul 10, 2022

Last updated

Jul 10, 2022By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Essential Physiotherapy and Wellness Clinic, LLC

  • Physical Therapist
  • San Antonio, TX
  • NPI 1285368951
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1657411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657411200000",
    "number": "1396479069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "377 LEIGH LN",
            "city": "STONEWALL",
            "state": "LA",
            "postal_code": "710785414",
            "telephone_number": "318-458-9464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "423 TREELINE PARK STE 201",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782092078",
            "telephone_number": "210-602-0235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON-ELLIS",
        "first_name": "CHASITY",
        "middle_name": "RENEA",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-10",
        "last_updated": "2022-07-10",
        "certification_date": "2022-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "LA",
            "license": "07075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Jacko, FNP
• Stacey Jacks, RN
• Jackson Neuroscience Center
• Lori Jackson-Bogle, P.A.
• Laurel Jackson-Cook, LPC
• Erica Rena Jackson-Harges
• Ada L. Jackson, COTA
• Agnes W Jackson
• Amalia Jackson
• Amari Jackson

• Physical Therapist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.