Active NPI
Jackson Taylor
- Physical Therapist
- Wallingford, CT
National Provider Identifier
1881251585
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 12178
- Practice address
- 863 N Main Street Ext Ste 200
Wallingford, CT 06492-2434 - Phone
- (203) 265-3280
- NPI assigned
- May 29, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 24093 | MA | |
| Physical Therapist | 225100000X | 12178 | CT | Primary |
Addresses
Primary practice location
863 N Main Street Ext Ste 200
Wallingford, CT 06492-2434
Mailing address
655 S Willow St Ste 128
Manchester, NH 03103-5705
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24093 | MA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559088000000",
"number": "1881251585",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "655 S WILLOW ST STE 128",
"city": "MANCHESTER",
"state": "NH",
"postal_code": "031035705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "863 N MAIN STREET EXT STE 200",
"city": "WALLINGFORD",
"state": "CT",
"postal_code": "064922434",
"telephone_number": "203-265-3280"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAYLOR",
"first_name": "JACKSON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-05-29",
"last_updated": "2019-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "24093",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CT",
"license": "12178",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wallingford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.