Jennifer Lackley, RPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT005260 Issued in GA

Practice address

109 Martin Luther King Jr Dr
Forsyth, GA 31029-1689

Phone

(478) 994-3390

Fax

(478) 845-6252

NPI assigned

Oct 7, 2015

Last updated

Oct 7, 2015By 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 GA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Medical College of Georgia School of Medicine, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Healing Arts Physical TherapyGroup PAC ID 0547347817, 5 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Healing Arts Physical Therapy

  dba Monroe Physical Therapy

  • Physical Therapist
  • Forsyth, GA
  • NPI 1659552461
  Medicare reassignment Care Compare group NPD
• Dialysis Center of Forsyth LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Forsyth, GA
  • NPI 1982125142
  NPD (past)

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

{
    "created_epoch": "1444176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444176000000",
    "number": "1881064582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 ROCKY CREEK CT",
            "city": "FORSYTH",
            "state": "GA",
            "postal_code": "310295301",
            "telephone_number": "478-994-3390",
            "fax_number": "478-845-6252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 MARTIN LUTHER KING JR DR",
            "city": "FORSYTH",
            "state": "GA",
            "postal_code": "310291689",
            "telephone_number": "478-994-3390",
            "fax_number": "478-845-6252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACKLEY",
        "first_name": "JENNIFER",
        "credential": "RPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-07",
        "last_updated": "2015-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT005260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Internal Medicine Associates of Middle Georgia, P.C.
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• Amber R. Johnston, LMSW
• Marissa Jones, LPC
• Jovita&Sons Medical Transport LLC
• Krystal Laidler, FNP
• Lawson and Cromer Inc (Lawson and Cromer Pharmacy)
• Darrce Carolyn Leonard, CNM
• Whitney Lovett
• M3 Solutions Group, LLC

• Physical Therapist in Forsyth, GA
• Providers in Forsyth, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2015; 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.