Active NPI
Rebecca L Jackson Wang, MS PT
- Physical Therapist
- Woodburn, OR
National Provider Identifier
1629289301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 04502
- Practice address
- 2241 Country Club Rd
Woodburn, OR 97071-2811 - Phone
- (503) 982-8544
- NPI assigned
- May 24, 2007
- Last updated
- Feb 18, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 04502 | OR | Primary |
| Physical Therapist | 225100000X | PT00008445 | WA |
Addresses
Primary practice location
2241 Country Club Rd
Woodburn, OR 97071-2811
Mailing address
2241 Country Club Rd
Woodburn, OR 97071-2811
Phone (503) 982-8544
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 181491 | Medicaid | OR | |
| 824151013 | Other | BLUE CROSS BLUE SHIELD |
Other names 1
- Ms. Rebecca Lynne Jackson
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT00008445 | WA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premere Rehab 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392681600000",
"number": "1629289301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2241 COUNTRY CLUB RD",
"city": "WOODBURN",
"state": "OR",
"postal_code": "970712811",
"telephone_number": "503-982-8544"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2241 COUNTRY CLUB RD",
"city": "WOODBURN",
"state": "OR",
"postal_code": "970712811",
"telephone_number": "503-982-8544"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WANG",
"first_name": "REBECCA",
"middle_name": "L JACKSON",
"credential": "MS PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-24",
"last_updated": "2014-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "04502",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT00008445",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "181491",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "824151013",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"first_name": "REBECCA",
"last_name": "JACKSON",
"middle_name": "LYNNE",
"prefix": "MS.",
"credential": "MS PT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Woodburn, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 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.