Elise M Jackson, DPT

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

2305206461 Issued in VA

Practice address

601 Childrens LN
Norfolk, VA 23507-1910

Phone

(757) 668-7000

NPI assigned

Jul 15, 2010

Last updated

Jul 15, 2010By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1279152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279152000000",
    "number": "1932412343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 BRANDON AVE",
            "address_2": "APT 4B",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071153",
            "telephone_number": "757-668-9015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 CHILDRENS LN",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071910",
            "telephone_number": "757-668-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ELISE",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-15",
        "last_updated": "2010-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "VA",
            "license": "2305206461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIRGINIA BOARD OF PHYSICAL THERAPY LICENSE",
            "identifier": "2305206461",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ivyrehab Sept, LLC (Southeastern Physical Therapy)
• Sylvester Chukwudi Izah, D.O.
• Jabuda LLC
• Adrienne Jackson, AU.D.
• Christopher Jackson, M.D.
• Jarrell T Jackson
• Jordan Jackson, PA
• Kari L Jackson, AG-ACNP
• Kourtney Almeitha Jackson
• Ronda Jackson

• Pediatric Physical Therapist in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Pediatric Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.