Active NPI
Frederick Jackson
- Physical Therapy Assistant
- Denton, TX
National Provider Identifier
1689155772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2139377
- Practice address
- 2244 Brinker Rd
Denton, TX 76208-6120 - Phone
- (940) 320-6300
- NPI assigned
- Aug 27, 2018
- Sex
- Male
- 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 | 2139377 | TX | Primary |
Addresses
Primary practice location
2244 Brinker Rd
Denton, TX 76208-6120
Mailing address
2007 Teasley LN Apt 117
Denton, TX 76205-8221
Phone (972) 489-3620
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 |
|---|---|---|---|
| 2139377 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1535328000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1535328000000",
"number": "1689155772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2007 TEASLEY LN APT 117",
"city": "DENTON",
"state": "TX",
"postal_code": "762058221",
"telephone_number": "972-489-3620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2244 BRINKER RD",
"city": "DENTON",
"state": "TX",
"postal_code": "762086120",
"telephone_number": "940-320-6300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "FREDERICK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-27",
"last_updated": "2018-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2139377",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Denton, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.