Shannon Jackson, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2306605329 Issued in VA

Practice address

730 Thimble Shoals Blvd Ste 130
Newport News, VA 23606-4562

Phone

(757) 873-1554

NPI assigned

May 7, 2019

Sex

Female

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

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

{
    "created_epoch": "1557187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557187200000",
    "number": "1407411366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 THIMBLE SHOALS BLVD STE 130",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236064562",
            "telephone_number": "757-873-1554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 THIMBLE SHOALS BLVD STE 130",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236064562",
            "telephone_number": "757-873-1554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHANNON",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-07",
        "last_updated": "2019-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "VA",
            "license": "2306605329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Jackson
• Lacey J Jackson, PHARMD
• Makayla Azaria Jackson
• Meria Eisenbraun Jackson, CRNA, MSN
• Michele Eloise Jackson, RESIDENT IN COUNSELI
• Nesreen Jacob
• Cassie Jacobs, LCSW
• George Allan Jacobs, D.D.S.
• Tania Erin Jacobson, NP
• Robert Marc Jaffee, MD

• Physical Therapy Assistant in Newport News, VA
• Providers in Newport News, VA by specialty
• Physical Therapy Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2019; 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.