Active NPI
Jeanna Patrice Jackson, DPT, ATC
- Physical Therapist
- Washington, DC
National Provider Identifier
1811260052
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 23935
- Practice address
- 2021 K St NW
Suite 750
Washington, DC 20006-1003 - Phone
- (202) 293-1853
- NPI assigned
- Feb 20, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 871328 | DC | |
| Physical Therapist | 225100000X | 2305209240 | VA | |
| Physical Therapist | 225100000X | 23935 | MD | Primary |
Addresses
Primary practice location
2021 K St NW
Suite 750
Washington, DC 20006-1003
Mailing address
102 Irving St NW
Washington, DC 20010-2921
Phone (202) 877-1566
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 |
|---|---|---|---|
| 871328 | DC | MD | Physical Therapist |
| 23935 | MD | MD | Physical Therapist |
| 2305209240 | VA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1329696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1422316800000",
"number": "1811260052",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 IRVING ST NW",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200102921",
"telephone_number": "202-877-1566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2021 K ST NW",
"address_2": "SUITE 750",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200061003",
"telephone_number": "202-293-1853"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JEANNA",
"middle_name": "PATRICE",
"name_prefix": "Dr.",
"credential": "DPT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-02-20",
"last_updated": "2015-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "DC",
"license": "871328",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "VA",
"license": "2305209240",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MD",
"license": "23935",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 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.