Active NPI
Tracy L Jackson, OT
- Physical Therapy Assistant
- Boynton Beach, FL
National Provider Identifier
1891739868
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 04215
- Practice address
- 2500 Quantum Lakes Dr
Suite 108
Boynton Beach, FL 33426-8324 - Phone
- (561) 244-3627
- Fax
- (561) 244-9627
- NPI assigned
- Jun 16, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 04215 | OH | Primary |
Addresses
Primary practice location
2500 Quantum Lakes Dr
Suite 108
Boynton Beach, FL 33426-8324
Mailing address
2500 Quantum Lakes Dr
Suite 108
Boynton Beach, FL 33426-8324
Phone (561) 244-3627
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PTA 04215 | Other | OH | PTA |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04215 | OH | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1891739868",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2500 QUANTUM LAKES DR",
"address_2": "SUITE 108",
"city": "BOYNTON BEACH",
"state": "FL",
"postal_code": "334268324",
"telephone_number": "561-244-3627",
"fax_number": "561-244-9627"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 QUANTUM LAKES DR",
"address_2": "SUITE 108",
"city": "BOYNTON BEACH",
"state": "FL",
"postal_code": "334268324",
"telephone_number": "561-244-3627",
"fax_number": "561-244-9627"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "TRACY",
"middle_name": "L",
"name_prefix": "Ms.",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-16",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "OH",
"license": "04215",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTA",
"identifier": "PTA 04215",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boynton Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.