Active NPI
Mary Cobbs Jackson, PT
- Physical Therapist
- Shreveport, LA
National Provider Identifier
1669740130
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 07663
- Practice address
- 1700 Buckner St Ste 150
Shreveport, LA 71101-4407 - Phone
- (318) 218-1993
- NPI assigned
- Dec 12, 2011
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 07663 | LA | Primary |
Addresses
Primary practice location
1700 Buckner St Ste 150
Shreveport, LA 71101-4407
Mailing address
613 Dumaine Drive
Bossier City, LA 71111
Phone (318) 218-1993
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 |
|---|---|---|---|
| 07663 | LA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663286400000",
"number": "1669740130",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "613 DUMAINE DRIVE",
"city": "BOSSIER CITY",
"state": "LA",
"postal_code": "71111",
"telephone_number": "318-218-1993"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 BUCKNER ST STE 150",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711014407",
"telephone_number": "318-218-1993"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MARY",
"middle_name": "COBBS",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-12-12",
"last_updated": "2022-09-16",
"certification_date": "2022-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "LA",
"license": "07663",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 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.