Sequoyha Raechelle Outlaw, PT

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

12410 Issued in TN

Practice address

176C W University Pkwy # C
Jackson, TN 38305-1616

Phone

(731) 300-4950

Fax

(731) 300-4951

NPI assigned

Sep 18, 2019

Last updated

Sep 18, 2019By the provider in NPPES

Sex

Female

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

Enrolled in TN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jackson Clinic PAGroup PAC ID 2668376872, 171 clinicians

45 Urgent Care PCGroup PAC ID 8628299617, 6 clinicians

Infinite Rehab and Wellness LLCGroup PAC ID 1557796877, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• 45 Urgent Care, P.C.

  • Family Medicine Physician
  • Jackson, TN
  • NPI 1912326539
  Medicare reassignment Care Compare group NPD
• Infinite Rehab and Wellness LLC

  • Physical Therapy Clinic/Center
  • Jackson, TN
  • NPI 1649815150
  Medicare reassignment Care Compare group NPD
• Jackson Clinic PA

  • Internal Medicine Physician
  • Jackson, TN
  • NPI 1285629386
  Medicare reassignment Care Compare group NPD
• Patterson Physical Therapy LLC

  • Physical Medicine & Rehabilitation Physician
  • Jackson, TN
  • NPI 1770928533
  Medicare reassignment NPD
• Jackson Clinic PA

  dba Jackson Clinc PA DME

  • Durable Medical Equipment & Medical Supplies
  • Jackson, TN
  • NPI 1689443038
  NPD

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

{
    "created_epoch": "1568764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568764800000",
    "number": "1659921948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "176C W UNIVERSITY PKWY # C",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383051616",
            "telephone_number": "731-300-4950",
            "fax_number": "731-300-4951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "176C W UNIVERSITY PKWY # C",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383051616",
            "telephone_number": "731-300-4950",
            "fax_number": "731-300-4951"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 US Highway 45 W",
            "address_purpose": "LOCATION",
            "city": "Humboldt",
            "state": "TN",
            "postal_code": "383438503",
            "country_code": "US",
            "telephone_number": "731-784-7771",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OUTLAW",
        "first_name": "SEQUOYHA",
        "middle_name": "RAECHELLE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-18",
        "last_updated": "2019-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "TN",
            "license": "12410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oneaxis LLC (Vital Care of Jackson TN)
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• Oral Surgery Associates of West Tennessee
• Orthodontic Specialty Group P.a.
• Michael O Osayamen, M.D.
• Francine Owens, LCSW
• Robert Henry Owens, FNP
• Terrie Owens
• Stephanie Renee Ozier, BSW
• Joanna Padgett, OT

• Physical Medicine & Rehabilitation Physician in Jackson, TN
• Providers in Jackson, TN by specialty
• Physical Medicine & Rehabilitation Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.