Samuel Collins Jackson, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

10222 Issued in SC

Practice address

104 Mauldin Rd Ste B
Greenville, SC 29605-1221

Phone

(864) 214-6680

Fax

(864) 309-8043

NPI assigned

Jun 3, 2020

Sex

Male

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 SC

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Foundation Physical Therapy LLCGroup PAC ID 5597136507, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Foundation Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Greenville, SC
  • NPI 1124743331

  Physical Therapist

  Medicare reassignment Care Compare group NPD Authorized official
• Imagine Physical Therapy LLC

  • Physical Therapist
  • Mt Pleasant, SC
  • NPI 1245241041
  Medicare reassignment NPD
• Imagine Physical Therapy North Rhett LLC

  • Physical Therapy Clinic/Center
  • North Charleston, SC
  • NPI 1033518766

  Physical Therapist

  Medicare reassignment NPD
• Imagine Physical Therapy Old Village LLC

  • Physical Therapy Clinic/Center
  • Mt Pleasant, SC
  • NPI 1477937662

  Physical Therapist

  Medicare reassignment NPD
• Imagine Physical Therapy on Daniel Island LLC

  • Physical Therapy Clinic/Center
  • Charleston, SC
  • NPI 1972770733

  Physical Therapist

  Medicare reassignment NPD
• Imagine Physical Therapy in West Ashley, LLC

  • Physical Therapy Clinic/Center
  • Charleston, SC
  • NPI 1588977862
  Medicare reassignment
• Love of Language

  • Speech-Language Pathologist
  • Mt Pleasant, SC
  • NPI 1184163842
  NPD (past)

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

{
    "created_epoch": "1591142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780358400000",
    "number": "1811511199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 MAULDIN RD STE B",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296051221",
            "telephone_number": "864-214-6680",
            "fax_number": "864-309-8043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 MAULDIN RD STE B",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296051221",
            "telephone_number": "864-214-6680",
            "fax_number": "864-309-8043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SAMUEL",
        "middle_name": "COLLINS",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-03",
        "last_updated": "2026-06-02",
        "certification_date": "2026-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "10222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Elizabeth Jackson, M.S., CCC-SLP
• Mark R Jackson, MD
• Marylee Jackson, PA
• Michelle Antonia Jackson
• Nina Katherine Trent Jackson, PA-C
• Tiffany Michelle Jackson, LPN
• Timothy G Jackson, MMFT, LMFT-A
• Tyla Jackson
• William Henry Jackson Jr., M.D., M.B.A
• William Morgan Jackson, DPT

• Physical Therapist in Greenville, SC
• Providers in Greenville, SC by specialty
• Physical Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2026; 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.