Mark Franklin Jackson, P.T., DPT, MPS, OCS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

020487 Issued in NY

Practice address

10 Brentwood Dr
Suite a
Ithaca, NY 14850-1865

Phone

(607) 274-4159

Fax

(607) 274-4675

NPI assigned

Jan 18, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Fadden & Associates Physical Therapy PLLC

  • Physical Therapist
  • Cortland, NY
  • NPI 1871701177
  NPD (past)

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330300800000",
    "number": "1467504365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 EVERGREEN ST",
            "city": "CORTLAND",
            "state": "NY",
            "postal_code": "130451109",
            "telephone_number": "607-423-7509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 BRENTWOOD DR",
            "address_2": "SUITE A",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148501865",
            "telephone_number": "607-274-4159",
            "fax_number": "607-274-4675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARK",
        "middle_name": "FRANKLIN",
        "credential": "P.T., DPT, MPS, OCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2012-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "020487",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EXCELLUS BCBS",
            "identifier": "000142682",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTHCARE",
            "identifier": "7475387",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "4123843",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ithaca Therapy Works, SLP, OT, PLLC
• Ithaca Urology PLLC
• Alisson Daniela Iturburu Altamirano, M.D.
• William Roy Ives
• Yudelka Garcia Ivory, N.P.
• Jaclyn Borza Maher, D.C., PLLC
• Amy Lee Jacobs, LISW
• Paula L. Jacobs, LCSW
• Patti L Jacobson, DC
• Kimberly Brett Jakobson

• Physical Therapist in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 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.