Active NPI
Jessica Elizabeth Tkachuk, DPT
- Physical Therapist
- Berkeley, CA
National Provider Identifier
1578808648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 39647
- Practice address
- 2030 Addison St
101
Berkeley, CA 94704-1158 - Phone
- (510) 644-8031
- NPI assigned
- Nov 30, 2012
- 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 | 39647 | CA | Primary |
Addresses
Primary practice location
2030 Addison St
101
Berkeley, CA 94704-1158
Mailing address
2416 Potter St
Oakland, CA 94601-4826
Phone (857) 413-7600
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 |
|---|---|---|---|
| 39647 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| G Sports Physical Therapy, Inc. | 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
- Berkeley, CA
- NPI 1396044194
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1354233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354233600000",
"number": "1578808648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2416 POTTER ST",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946014826",
"telephone_number": "857-413-7600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2030 ADDISON ST",
"address_2": "101",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947041158",
"telephone_number": "510-644-8031"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TKACHUK",
"first_name": "JESSICA",
"middle_name": "ELIZABETH",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-11-30",
"last_updated": "2012-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "39647",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 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.