Jordon Jacklin, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1635 Issued in WY

Practice address

111 S 5TH St
Douglas, WY 82633-2434

Phone

(307) 358-9464

Fax

(307) 358-9330

NPI assigned

Jul 13, 2020

Last updated

Jul 13, 2020By the provider in NPPES

Sex

Male

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 WY, UT2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Professional Therapy and Rehabilitation LLCGroup PAC ID 3476441767, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Professional Therapy and Rehabilitation LLC

  dba Peak Physical Therapy and Sports Medicine

  • Physical Therapist
  • Spanish Fork, UT
  • NPI 1629259189
  Medicare reassignment Care Compare group NPD
• Bear Lodge Rehabilitation Services, LLC

  • Physical Therapist
  • Sundance, WY
  • NPI 1558690099
  Medicare reassignment NPD
• Big Country Rehabilitation,LLC

  • Physical Therapist
  • Douglas, WY
  • NPI 1366493264
  Medicare reassignment NPD
• Memorial Hospital of Converse County

  • General Practice Physician
  • Douglas, WY
  • NPI 1356496491
  NPD (past)

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

{
    "created_epoch": "1594598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594598400000",
    "number": "1467070730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1790",
            "city": "DOUGLAS",
            "state": "WY",
            "postal_code": "826331790",
            "telephone_number": "307-358-9464",
            "fax_number": "307-358-9330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 5TH ST",
            "city": "DOUGLAS",
            "state": "WY",
            "postal_code": "826332434",
            "telephone_number": "307-358-9464",
            "fax_number": "307-358-9330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKLIN",
        "first_name": "JORDON",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-13",
        "last_updated": "2020-07-13",
        "certification_date": "2020-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WY",
            "license": "1635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ruth Ann Holland
• Shelby Hoskinson, OT
• Wayne Hudson
• Melanie Hummert, DPT
• Inspirecare, LLC
• Jciloa (Edward Michael Tucker JILOA)
• Katie Jenkins
• Deeanne Joy Johnson-Engle, M.D.
• Jessica Paige Johnson, SLP/A
• Julie Lynn Johnson, APRN

• Physical Therapist in Douglas, WY
• Providers in Douglas, WY by specialty
• Physical Therapist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.