Paul Charles Jackson, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

7580A Issued in AZ

Practice address

660 S Coronado Dr
Sierra Vista, AZ 85635-3386

Phone

(520) 459-4900

NPI assigned

Jun 16, 2008

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1213574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213574400000",
    "number": "1639339443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5446 S SAN PAULO AVE",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856509356",
            "telephone_number": "520-378-0744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 S CORONADO DR",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856353386",
            "telephone_number": "520-459-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "PAUL",
        "middle_name": "CHARLES",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-16",
        "last_updated": "2008-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "AZ",
            "license": "7580A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Justin Israelsen, DMD
• Andrea Jackson, FNP-BC
• Janell Ann Jackson, R.N.
• Joan Lynne Jackson, OTR/L
• Marissa Jackson
• Dawn Marie Jacobson, RN
• Debbie Jacques, N.M.D.
• James a Griggs Cochise Womens Care PLLC
• James B. Leavitt D.M.D., P.C.
• Jamie M Moenster DO PC

• Physical Therapy Assistant in Sierra Vista, AZ
• Providers in Sierra Vista, AZ by specialty
• Physical Therapy Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.

Verify at the official NPI Registry.