Active NPI
Sandra Renee Jackson, PT, DPT, CHT
- Physical Therapist
- Manlius, NY
National Provider Identifier
1740425735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 025060
- Practice address
- 4476 Winding Creek Rd
Manlius, NY 13104-2482 - Phone
- (315) 682-8341
- NPI assigned
- Dec 5, 2008
- 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 | 025060 | NY | Primary |
Addresses
Primary practice location
4476 Winding Creek Rd
Manlius, NY 13104-2482
Mailing address
4476 Winding Creek Rd
Manlius, NY 13104-8342
Phone (315) 682-8341
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 |
|---|---|---|---|
| 025060 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1228435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424995200000",
"number": "1740425735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4476 WINDING CREEK RD",
"city": "MANLIUS",
"state": "NY",
"postal_code": "131048342",
"telephone_number": "315-682-8341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4476 WINDING CREEK RD",
"city": "MANLIUS",
"state": "NY",
"postal_code": "131042482",
"telephone_number": "315-682-8341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SANDRA",
"middle_name": "RENEE",
"credential": "PT, DPT, CHT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-12-05",
"last_updated": "2015-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "025060",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manlius, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.