Active NPI
John Jackson
- Physical Therapy Assistant
- Chittenango, NY
National Provider Identifier
1992202832
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 011063
- Practice address
- 209 Lake St
Chittenango, NY 13037-1518 - Phone
- (315) 256-3615
- NPI assigned
- Apr 8, 2018
- Last updated
- Apr 8, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 011063 | NY | Primary |
Addresses
Primary practice location
209 Lake St
Chittenango, NY 13037-1518
Mailing address
209 Lake St
Chittenango, NY 13037-1518
Phone (315) 256-3615
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 |
|---|---|---|---|
| 011063 | NY | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1523145600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523145600000",
"number": "1992202832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "209 LAKE ST",
"city": "CHITTENANGO",
"state": "NY",
"postal_code": "130371518",
"telephone_number": "315-256-3615"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "209 LAKE ST",
"city": "CHITTENANGO",
"state": "NY",
"postal_code": "130371518",
"telephone_number": "315-256-3615"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JOHN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-04-08",
"last_updated": "2018-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NY",
"license": "011063",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chittenango, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.