Ingrid Lyn Iversen, RPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

CO4074 Issued in CO

Practice address

755 E 2ND Ave
Suite E
Durango, CO 81301-5498

Phone

(970) 385-1773

NPI assigned

Oct 27, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1256601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256601600000",
    "number": "1598091498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 E 2ND AVE",
            "address_2": "SUITE E",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813015498",
            "telephone_number": "970-385-1773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 E 2ND AVE",
            "address_2": "SUITE E",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813015498",
            "telephone_number": "970-385-1773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVERSEN",
        "first_name": "INGRID",
        "middle_name": "LYN",
        "credential": "RPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-10-27",
        "last_updated": "2009-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "CO4074",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NM",
            "license": "NM3725",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NM LICENSE",
            "identifier": "NM3725",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "CO4074",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Lorielle M Jack
• Robin Oma Jackman, O.D.
• Alison W Jackson, M.D.
• Danette Jackson, RN

• Physical Therapist in Durango, CO
• Providers in Durango, CO by specialty
• Physical Therapist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2009; 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.