Active NPI
Keith Jackson, MPT
- Physical Therapist
- Wilmington, DE
National Provider Identifier
1952338337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- J1-0001883
- Practice address
- 1812 Marsh Rd
Store 505
Wilmington, DE 19810-4581 - Phone
- (302) 475-7500
- NPI assigned
- Jun 28, 2006
- Sex
- Male
- Sole proprietor
- No
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 | 21348 | MD | |
| Physical Therapist | 225100000X | J1-0001883 | DE | Primary |
Addresses
Primary practice location
1812 Marsh Rd
Store 505
Wilmington, DE 19810-4581
Mailing address
790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50700032 | Other | CAREFIRST | |
| 5070-0032 | Other | NCA | |
| 64343601 | Other | CARE FIRST | |
| 246555 | Other | MAMSI | |
| 64343601 | Other | CAREFIRST | |
| 1530795 | Other | PABS | |
| 2342330000 | Other | AMERIHEALTH |
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 |
|---|---|---|---|
| J1-0001883 | DE | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1379548800000",
"number": "1952338337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404909",
"telephone_number": "630-296-2223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1812 MARSH RD",
"address_2": "STORE 505",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198104581",
"telephone_number": "302-475-7500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KEITH",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-28",
"last_updated": "2013-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MD",
"license": "21348",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "DE",
"license": "J1-0001883",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREFIRST",
"identifier": "50700032",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCA",
"identifier": "5070-0032",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARE FIRST",
"identifier": "64343601",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI",
"identifier": "246555",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREFIRST",
"identifier": "64343601",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PABS",
"identifier": "1530795",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIHEALTH",
"identifier": "2342330000",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.