Active NPI
Mary Christine Jackson, P.T.
- Physical Therapist
- Glendale, AZ
National Provider Identifier
1982828349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1480
- Practice address
- 4650 W. Sweetwater Ave.
Glendale, AZ 85304 - Phone
- (602) 347-2600
- NPI assigned
- Apr 13, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 Therapist | 225100000X | 1480 | AZ | Primary |
Addresses
Primary practice location
4650 W. Sweetwater Ave.
Glendale, AZ 85304
Mailing address
937 W Campus Dr
Phoenix, AZ 85013-4017
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 558736 | Medicaid | AZ |
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 |
|---|---|---|---|
| 1480 | AZ | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1982828349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "937 W CAMPUS DR",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850134017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4650 W. SWEETWATER AVE.",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "85304",
"telephone_number": "602-347-2600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MARY",
"middle_name": "CHRISTINE",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "1480",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "558736",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.