NPIMap

Organization Active NPI

Physical Therapy of Jackson PC.

  • Physical Therapy Clinic/Center
  • Jackson, TN
National Provider Identifier
1841247418
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
261QP2000X Issued in TN
Legal business name
PHYSICAL THERAPY OF JACKSON PC.
Practice address
2782 N Highland Ave
Suite a
Jackson, TN 38305-1798
Phone
(731) 664-1172
Fax
(731) 664-3139
NPI assigned
May 28, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Alexander Luy, PT, MBANPI 1962574038
Title
President
Phone
(731) 664-1172

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 261QP2000X TN Primary

Addresses

Primary practice location

2782 N Highland Ave
Suite a
Jackson, TN 38305-1798

Mailing address

2782 N Highland Ave
Suite a
Jackson, TN 38305-1798
Phone (731) 664-1172

Other identifiers 1

IdentifierTypeStateIssuer
3654237MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041028000487 TN Part B Supplier - Clinic/Group Practice 2961462627 Receives reassigned benefits from 1 practitioner
Practice locations: Jackson, TN

National Provider Directory

National Provider Directory

Locations

2782 N Highland Ave
Ste A
Jackson, TN 38305
Phone (731) 664-1172

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1841247418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2782 N HIGHLAND AVE",
            "address_2": "SUITE A",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383051798",
            "telephone_number": "731-664-1172",
            "fax_number": "731-664-3139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2782 N HIGHLAND AVE",
            "address_2": "SUITE A",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383051798",
            "telephone_number": "731-664-1172",
            "fax_number": "731-664-3139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL THERAPY OF JACKSON PC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LUY",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "731-664-1172",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT, MBA"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "TN",
            "license": "261QP2000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3654237",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.