Active NPI
Tracie Lashelle Jackson, P.T., DPT
- Physical Therapist
- Baton Rouge, LA
National Provider Identifier
1487948154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 08369R
- Practice address
- 10101 Park Rowe Ave
Ste. 200
Baton Rouge, LA 70810-1686 - Phone
- (225) 769-2200
- Fax
- (225) 768-2185
- NPI assigned
- May 31, 2011
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | |||
| Physical Therapist | 225100000X | 08369R | LA | Primary |
| Physical Therapist | 225100000X | 010349 | GA |
Addresses
Primary practice location
10101 Park Rowe Ave
Ste. 200
Baton Rouge, LA 70810-1686
Mailing address
PO Box 98509
Baton Rouge, LA 70884-9509
Phone (225) 769-2200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08369R | Other | LA | P.T. LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010349 | GA | MD | Physical Therapist |
| 08369R | LA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therapeutic by Design Fitness and Wellness, LLC | Physical Therapist | Past | Accepting new patients |
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.
-
- Physical Therapist
- Mandeville, LA
- NPI 1790780120
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1306800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395187200000",
"number": "1487948154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 98509",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708849509",
"telephone_number": "225-769-2200",
"fax_number": "225-768-2185"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10101 PARK ROWE AVE",
"address_2": "STE. 200",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708101686",
"telephone_number": "225-769-2200",
"fax_number": "225-768-2185"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "TRACIE",
"middle_name": "LASHELLE",
"name_prefix": "Miss",
"credential": "P.T., DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-05-31",
"last_updated": "2014-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "LA",
"license": "08369R",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "010349",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "P.T. LICENSE",
"identifier": "08369R",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Baton Rouge, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.