Active NPI
Susan Jackson, PT
- Physical Therapist
- West Melbourne, FL
National Provider Identifier
1609042639
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT6052
- Practice address
- 3275 Soft Breeze Cir
West Melbourne, FL 32904-7710 - Phone
- (321) 223-7570
- NPI assigned
- Apr 30, 2008
- 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 | PT6052 | FL | Primary |
Addresses
Primary practice location
3275 Soft Breeze Cir
West Melbourne, FL 32904-7710
Mailing address
3275 Soft Breeze Cir
West Melbourne, FL 32904-7710
Phone (321) 223-7570
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Direct Access Counseling & Supportive Services, LLC | Past | Accepting new patients |
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Arcadia, FL
- NPI 1679011449
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209513600000",
"number": "1609042639",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3275 SOFT BREEZE CIR",
"city": "WEST MELBOURNE",
"state": "FL",
"postal_code": "329047710",
"telephone_number": "321-223-7570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3275 SOFT BREEZE CIR",
"city": "WEST MELBOURNE",
"state": "FL",
"postal_code": "329047710",
"telephone_number": "321-223-7570"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SUSAN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-04-30",
"last_updated": "2008-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT6052",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.