Individual provider Active NPI

Jacqueline Hart Stone Fussell, PT

  • Physical Therapist
  • Lakeland, FL
National Provider Identifier
1982435871
Registry record updated Oct 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT41985 Issued in FL
Practice address
2300 E County Road 540a
Lakeland, FL 33813-3825
Phone
(863) 680-7700
NPI assigned
Aug 12, 2024
Last updated
Oct 27, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT41985 FL Primary

Addresses

Primary practice location

2300 E County Road 540a
Lakeland, FL 33813-3825

Mailing address

5010 Barush Rd
Bartow, FL 33830-9623

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240826003917 FL Practitioner - Physical Therapist in Private Practice 1850830555 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Watson Clinic LLPGroup PAC ID 1456258979, 365 clinicians

Practice addresses (Care Compare)

1430 Lakeland Hills Blvd
Lakeland, FL 33805-3202
Phone (863) 680-7337

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Watson Clinic LLP CurrentSince Aug 19, 2024 Accepting new patients

Locations

1430 Lakeland Hills Blvd
Lakeland, FL 33805
Phone (863) 680-7337

1600 Lakeland Hills Blvd
Lakeland, FL 33805
Phone (863) 680-7190

2190 E County Road 540A
Lakeland, FL 33813
Phone (863) 607-3699

2300 E County Road 540A
Lakeland, FL 33813
Phone (863) 607-3333

Interoperability endpoints

  • Direct secure messaging: jfussell22815@direct.watsonclinicad.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1723420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1793059200000",
    "number": "1982435871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5010 BARUSH RD",
            "city": "BARTOW",
            "state": "FL",
            "postal_code": "338309623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 E COUNTY ROAD 540A",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338133825",
            "telephone_number": "863-680-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUSSELL",
        "first_name": "JACQUELINE",
        "middle_name": "HART STONE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-12",
        "last_updated": "2026-10-27",
        "certification_date": "2026-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT41985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2026; 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.