Active NPI
Jennifer Jackson
- Physical Therapist
- Terre Haute, IN
National Provider Identifier
1407612062
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05007782A
- Practice address
- 1450 E Crossing Blvd
Terre Haute, IN 47802-5316 - Phone
- (812) 575-4057
- NPI assigned
- Feb 22, 2024
- 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 | 05007782A | IN | Primary |
Addresses
Primary practice location
1450 E Crossing Blvd
Terre Haute, IN 47802-5316
Mailing address
6084 Woodchuck Dr
Pendleton, IN 46064-8739
Phone (317) 698-0558
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05007782A | IN | MD | Physical Therapist |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Rehabilitation Clinic/Center
- Terre Haute, IN
- NPI 1225792534
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1708560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708646400000",
"number": "1407612062",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6084 WOODCHUCK DR",
"city": "PENDLETON",
"state": "IN",
"postal_code": "460648739",
"telephone_number": "317-698-0558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1450 E CROSSING BLVD",
"city": "TERRE HAUTE",
"state": "IN",
"postal_code": "478025316",
"telephone_number": "812-575-4057"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JENNIFER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-02-22",
"last_updated": "2024-02-23",
"certification_date": "2024-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05007782A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Terre Haute, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2024; 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.