Kyle Jackson, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT27666 Issued in CA

Practice address

1310 Casa Grande Rd
Suite B
Petaluma, CA 94954-5603

Phone

(707) 782-0921

Fax

(707) 782-0926

NPI assigned

Sep 13, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Next Level Physical Therapy IncGroup PAC ID 3870899800, 2 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.

• Next Level Physical Therapy Inc.

  • Physical Therapist
  • Petaluma, CA
  • NPI 1003280801
  Medicare reassignment Care Compare group NPD Authorized official
• Backtogolf Performance & Fitness Inc

  • Physical Therapist
  • Santa Rosa, CA
  • NPI 1669571188
  NPD (past)

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1861597908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10",
            "city": "WINDSOR",
            "state": "CA",
            "postal_code": "954920010",
            "telephone_number": "707-837-7980",
            "fax_number": "707-837-7983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 CASA GRANDE RD",
            "address_2": "SUITE B",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949545603",
            "telephone_number": "707-782-0921",
            "fax_number": "707-782-0926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KYLE",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-13",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT27666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GRP ID#",
            "identifier": "ZZZ231187",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROV GRP #",
            "identifier": "ZZZ00793Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Island Heart Transport LLC
• Judy B Iwanier, MSW, LCSW
• Jason Anton Jaber, DDS
• Ryan Richard Jablonowski
• Susana Jacinto Diaz
• Janette S Jacobs
• Lina Jadid, PHARMD
• Marilyn Lee Jaffe
• John Jahrling
• James J. Glynn, M.D. a Medical Corporation

• Physical Therapist in Petaluma, CA
• Providers in Petaluma, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.