Brandon Leroy Jackson, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1365 Issued in NV

Practice address

4765 S. Durango Dr.
Ste 106
Las Vegas, NV 89147

Phone

(702) 898-7633

Fax

(702) 898-6433

NPI assigned

Jun 6, 2006

Sex

Male

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 NV

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brandon Jackson P TGroup PAC ID 2961480363, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Brandon Jackson, P T

  • Physical Therapist
  • Las Vegas, NV
  • NPI 1487682076
  Medicare reassignment Care Compare group Authorized official
• Brandon Jackson PT

  • Sports Physical Therapist
  • Las Vegas, NV
  • NPI 1205266764
  NPD Authorized official

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1952340671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4765 S. DURANGO DR.",
            "address_2": "STE 106",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89147",
            "telephone_number": "702-898-7633",
            "fax_number": "702-898-6433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4765 S. DURANGO DR.",
            "address_2": "STE 106",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89147",
            "telephone_number": "702-898-7633",
            "fax_number": "702-898-6433"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 N Green Valley Pkwy Ste 335",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "NV",
            "postal_code": "890747704",
            "country_code": "US",
            "telephone_number": "702-898-7633",
            "fax_number": "702-898-7633",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5550 Painted Mirage Rd Ste 106",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891494581",
            "country_code": "US",
            "telephone_number": "702-898-7633",
            "fax_number": "702-898-6433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BRANDON",
        "middle_name": "LEROY",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NV",
            "license": "1365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Jackson
• Author Jackson
• Betty Jackson
• Bianca Jackson
• Bobbie Jackson
• Branysha Jackson
• Breiyanna L Jackson, COTA/L
• Brenda Rene Jackson
• Breonna Elodia Ginave Jackson
• Britani Jackson

• Physical Therapist in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Physical Therapist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; 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.