Jackie J Kingma, DPT, ATC, PA-C, PT

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

05009744A Issued in IN

Practice address

1025 E 7TH St
Hper C202
Bloomington, IN 47405-7109

Phone

(812) 855-1233

NPI assigned

Feb 10, 2006

Last updated

Oct 15, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350259200000",
    "number": "1396718060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 E 7TH ST",
            "address_2": "HPER C202",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "47405",
            "telephone_number": "812-855-1233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 E 7TH ST",
            "address_2": "HPER C202",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474057109",
            "telephone_number": "812-855-1233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINGMA",
        "first_name": "JACKIE",
        "middle_name": "J",
        "credential": "DPT, ATC, PA-C, PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-10",
        "last_updated": "2012-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "IN",
            "license": "05009744A",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IN",
            "license": "36001566A",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayla E King, RD
• Kristen King
• Michel Joseph King, DDS
• Tasha King
• Tyler King
• Margret I. Kingrey, OTR
• Sheryl Lynn Kingston
• Meghan Elizabeth Kinkead, MS, LAT, ATC
• Dana Kinney, M.A.
• Gavin Kinsella

• Orthopedic Physical Therapist in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Orthopedic Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2012; 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.