Hannah Jacqueline Jackson, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2306604661 Issued in VA

Practice address

Kroontje Healthcare Center
100 Litton Lane
Blacksburg, VA 24060

Phone

(540) 443-3437

NPI assigned

Jan 4, 2019

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

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": "1546560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620345600000",
    "number": "1669945465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 PETRA PASS",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240608772",
            "telephone_number": "540-808-9132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "KROONTJE HEALTHCARE CENTER",
            "address_2": "100 LITTON LANE",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "24060",
            "telephone_number": "540-443-3437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "HANNAH",
        "middle_name": "JACQUELINE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-04",
        "last_updated": "2021-05-07",
        "certification_date": "2021-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "VA",
            "license": "2306604661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Integrated Self Counseling & Supervision, PLLC
• Internal Medicine of Blacksburg LLC
• Sadia Iqbal, DO
• Carissa L Isbell, PHARM. D.
• Ischemic Injured Organs and Limbs Foundation
• Kristie Lynn Jackson, NP
• Lukas Jackson, DPT
• Minna R Jackson, LPC
• William Materson Jackson, CRNFA
• Megan Jacobs

• Physical Therapy Assistant in Blacksburg, VA
• Providers in Blacksburg, VA by specialty
• Physical Therapy Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2021; 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.