Leo Jackson III, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT017004 Issued in GA

Practice address

1867 Harvard Ave
Atlanta, GA 30337-3526

Phone

(404) 835-4321

Fax

(404) 835-4320

NPI assigned

Feb 14, 2024

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

Medicare fee-for-service enrollment

Enrolled in GA, TX, MO3 enrollments

Enrollment records 3

Specialty

Physical Therapist in Private Practice

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Team Rehabilitation Services LLCGroup PAC ID 2264479518, 569 clinicians

Sportherapy LLCGroup PAC ID 0749536308, 45 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 and National Provider Directory roles.

• Team Rehabilitation Services, LLC

  • Physical Therapist
  • Marietta, GA
  • NPI 1508538158
  Medicare reassignment Care Compare group NPD
• Sportherapy LLC

  • Physical Therapy Clinic/Center
  • Fort Worth, TX
  • NPI 1386132132

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Preferred PT, LLC

  • Physical Therapist
  • Gladstone, MO
  • NPI 1154568665
  Medicare reassignment
• Preferred PT LLC

  • Physical Therapist
  • Leawood, KS
  • NPI 1336966852
  NPD
• Preferred PT, LLC

  • Physical Therapist
  • Kansas City, MO
  • NPI 1568830040
  NPD
• Gateway Partners Inc

  • Physical Therapist
  • Keller, TX
  • NPI 1902183643
  NPD (past)
• Sportherapy Southwest, PC

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Fort Worth, TX
  • NPI 1801812698

  Physical Therapist

  NPD (past)
• Team Rehabilitation Services, LLC

  • Physical Therapist
  • Bloomfield Hills, MI
  • NPI 1548932619
  NPD (past)

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

{
    "created_epoch": "1707868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787270400000",
    "number": "1588429161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33900 HARPER AVE STE 104",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480354258",
            "telephone_number": "586-350-2644",
            "fax_number": "586-541-3735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1867 HARVARD AVE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303373526",
            "telephone_number": "404-835-4321",
            "fax_number": "404-835-4320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LEO",
        "name_suffix": "III",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-14",
        "last_updated": "2026-08-21",
        "certification_date": "2026-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT017004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lana Jean Jackson, P.A.
• Larette Denise Jackson, CRNA
• Latasha Rachele Jackson, MSN, APRN, PMHNP-BC
• Latisha Ranae Jackson
• Lauren Victoria Jackson, OD
• Leopold L Jackson, MD
• Lorraine T. Jackson, SLP/CCC
• Lucy O Jackson, MSC, RD,CNS,IBCLC
• Madison Jackson
• Malaina Jackson

• Physical Therapist in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2026; 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.