NPIMap

Organization Active NPI

Brandon Jackson, P T

Doing business as Jackson Physical Therapy

  • Physical Therapist
  • Las Vegas, NV
National Provider Identifier
1487682076
Registry record updated Aug 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1365 Issued in NV
Legal business name
BRANDON JACKSON, P T
Doing business as
Jackson Physical Therapy
Practice address
4765 S. Durango Dr.
Ste 106
Las Vegas, NV 89147
Phone
(702) 898-7633
Fax
(702) 898-6433
NPI assigned
Jun 30, 2006
Last updated
Aug 12, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2025

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

Authorized official

Name
Mr. Brandon Leroy Jackson, P.T.NPI 1952340671
Title
Owner
Phone
(702) 898-7633

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1365 NV Primary

Addresses

Primary practice location

4765 S. Durango Dr.
Ste 106
Las Vegas, NV 89147

Mailing address

4765 S. Durango Dr.
Ste 106
Las Vegas, NV 89147
Phone (702) 898-7633

Other identifiers 1

IdentifierTypeStateIssuer
100506016MedicaidNV

Other names 1

  • Jackson Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040712001093 NV Part B Supplier - Clinic/Group Practice 2961480363 Receives reassigned benefits from 13 practitioners
Practice locations: Henderson, NV; Las Vegas, NV

National Provider Directory

National Provider Directory
Tax ID family
Brandon Jackson P T2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

100 N Green Valley Pkwy
Ste 335
Henderson, NV 89074
Phone (702) 898-7633

5550 Painted Mirage Rd
Ste 120
Las Vegas, NV 89149
Phone (702) 898-7633

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754956800000",
    "number": "1487682076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4765 S. DURANGO DR.",
            "address_2": "STE 106",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89147",
            "telephone_number": "702-898-7633",
            "fax_number": "702-898-6433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4765 S. DURANGO DR.",
            "address_2": "STE 106",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89147",
            "telephone_number": "702-898-7633",
            "fax_number": "702-898-6433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANDON JACKSON, P T",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2025-08-12",
        "certification_date": "2025-08-12",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "LEROY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-898-7633",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NV",
            "license": "1365",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100506016",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jackson Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2025; 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.

Verify at the official NPI Registry.