Kathleen Grace Jackson, DPT

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

9047266-2401 Issued in UT

Practice address

590 S Wakara Way
Salt Lake City, UT 84108-1200

Phone

(801) 587-7109

NPI assigned

Jul 27, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1406419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406419200000",
    "number": "1720496326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2927 E 3300 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841092138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 S WAKARA WAY",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081200",
            "telephone_number": "801-587-7109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KATHLEEN",
        "middle_name": "GRACE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-27",
        "last_updated": "2014-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251N0400X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Neurology",
            "state": "UT",
            "license": "9047266-2401",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "UT",
            "license": "9047266-2401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Ann Jackson, LCSW
• Jillyn Jackson, PTA
• John Lawrence Jackson, PHD
• Julie Jackson, M.D.
• Karena Z Jackson, LPPP
• Kenneth Conrad Jackson II, PHARM.D., R.PH.
• Marie C Jackson, MSW, CSW
• Matthew Kory Jackson, D.C.
• Michael Jackson
• Paul S. Jackson, D.M.D.

• Orthopedic Physical Therapist in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Orthopedic Physical Therapist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2014; 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.