Active NPI
Jody M Jackson
- Mechanotherapist
- West St Paul, MN
National Provider Identifier
1407235922
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mechanotherapist
- License
- 153830-6
- Practice address
- 33 Wentworth Ave E
Suite 240
West St Paul, MN 55118-3431 - Phone
- (612) 770-7565
- NPI assigned
- May 29, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mechanotherapist | 172M00000X | 153830-6 | MN | Primary |
Addresses
Primary practice location
33 Wentworth Ave E
Suite 240
West St Paul, MN 55118-3431
Mailing address
33 Wentworth Ave E
Suite 240
West St Paul, MN 55118-3431
Phone (612) 770-7565
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 153830-6 | MN | MD | Mechanotherapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1432857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1451088000000",
"number": "1407235922",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33 WENTWORTH AVE E",
"address_2": "SUITE 240",
"city": "WEST ST PAUL",
"state": "MN",
"postal_code": "551183431",
"telephone_number": "612-770-7565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33 WENTWORTH AVE E",
"address_2": "SUITE 240",
"city": "WEST ST PAUL",
"state": "MN",
"postal_code": "551183431",
"telephone_number": "612-770-7565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JODY",
"middle_name": "M",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-05-29",
"last_updated": "2015-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "172M00000X",
"taxonomy_group": "",
"desc": "Mechanotherapist",
"state": "MN",
"license": "153830-6",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West St Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.