Active NPI
Matthew Jackson, DPT, MOT,ATC
- Athletic Trainer
- Jena, LA
National Provider Identifier
1992027775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 07464
- Practice address
- 187 Ninth St
Jena, LA 71342-2780 - Phone
- (318) 992-9200
- Fax
- (318) 992-9280
- NPI assigned
- Feb 22, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 07464 | LA | |
| Athletic Trainer | 2255A2300X | 07464 | LA | Primary |
| Occupational Therapist | 225X00000X | 07464 | LA |
Addresses
Primary practice location
187 Ninth St
Jena, LA 71342-2780
Mailing address
187 Ninth St
Jena, LA 71342
Phone (318) 992-9200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07464 | Other | LA | LA STATE LICENSE |
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 |
|---|---|---|---|
| 07464 | LA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1266796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266796800000",
"number": "1992027775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "187 NINTH ST",
"city": "JENA",
"state": "LA",
"postal_code": "71342",
"telephone_number": "318-992-9200",
"fax_number": "318-992-9280"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "187 NINTH ST",
"city": "JENA",
"state": "LA",
"postal_code": "713422780",
"telephone_number": "318-992-9200",
"fax_number": "318-992-9280"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MATTHEW",
"credential": "DPT, MOT,ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-02-22",
"last_updated": "2010-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "LA",
"license": "07464",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "LA",
"license": "07464",
"primary": true
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "LA",
"license": "07464",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LA STATE LICENSE",
"identifier": "07464",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jena, LA
- Hospital Service District #2 of Lasalle Parish
- Hospital Service District #2 of Lasalle Parish
- Hospital Service District 2 of Lasalle
- Madelyn Lynn Hudnall, MS, SLP
- Ihsc @ Lasalle Detention Facility
- Jena Ess Hospitalist LLC
- Jena Ess LLC
- Jena Nursing and Rehabilitation Center LLC
- Jena Pharmacy LLC
- Ingrid Elizabeth Jennings
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 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.