Active NPI
Candace Rowe Jackson, PTA
- Physical Therapy Assistant
- Davidson, NC
National Provider Identifier
1639895816
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- A-3679
- Practice address
- 825 Peninsula Dr
Davidson, NC 28036-7302 - Phone
- (704) 896-3278
- NPI assigned
- Oct 18, 2022
- 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 Therapy Assistant | 225200000X | A-3679 | NC | Primary |
Addresses
Primary practice location
825 Peninsula Dr
Davidson, NC 28036-7302
Mailing address
2225 Jackson Rd
Mooresville, NC 28115-7514
Phone (828) 638-3593
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A-3679 | NC | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1666051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666051200000",
"number": "1639895816",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2225 JACKSON RD",
"city": "MOORESVILLE",
"state": "NC",
"postal_code": "281157514",
"telephone_number": "828-638-3593"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "825 PENINSULA DR",
"city": "DAVIDSON",
"state": "NC",
"postal_code": "280367302",
"telephone_number": "704-896-3278"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CANDACE",
"middle_name": "ROWE",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-10-18",
"last_updated": "2022-10-18",
"certification_date": "2022-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NC",
"license": "A-3679",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davidson, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.