Kathy Jackson, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT17158 Issued in FL

Practice address

10820 Marvin E. Jones Blvd.
Live Oak, FL 32060

Phone

(386) 658-5865

Fax

(386) 658-5542

NPI assigned

Nov 15, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

Enrolled in FL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Acv Community Services LLCGroup PAC ID 3476462078, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Acv Community Services LLC

  • Rural Health Clinic/Center
  • Live Oak, FL
  • NPI 1174630693
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811060379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "373 NE GID JACKSON LN",
            "city": "MAYO",
            "state": "FL",
            "postal_code": "32066",
            "telephone_number": "386-658-5865",
            "fax_number": "386-658-5542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10820 MARVIN E. JONES BLVD.",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "32060",
            "telephone_number": "386-658-5865",
            "fax_number": "386-658-5542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KATHY",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT17158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trudie Howard
• HQM of Surrey Place, LLC (Surrey Place Care Center)
• Audrey Corbett Hughes
• Patricia Darlene Hulsberg
• Integrated Regional Laboratories Pathology Services, LLC
• James Janousek, M.D.
• John Workman, DC, PLLC
• April Lynn Johnson
• Caspertine Johnson
• Jasmine S Jones

• Physical Therapist in Live Oak, FL
• Providers in Live Oak, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.