NPIMap

Individual provider Active NPI

Brittany Ann Jackson, PT, DPT

  • Physical Therapist
  • Montesano, WA
National Provider Identifier
1992453310
Registry record updated Aug 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
CP014479T Issued in WA
Practice address
800 Medcalf St
Montesano, WA 98563-1300
Phone
(360) 249-2273
NPI assigned
Mar 15, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 2, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 15753-24 WI
Physical Therapist 225100000X CP014479T WA Primary
Physical Therapist 225100000X LPT-30358 AZ

Addresses

Primary practice location

800 Medcalf St
Montesano, WA 98563-1300

Mailing address

1010 E Washington Ave Apt 507
Madison, WI 53703-4413
Phone (845) 978-3314

Other practice location 1

1010 E Washington Ave Apt 507
Madison, WI 53703-4413
Phone (845) 978-3314

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

LicenseStateTypeSpecialty
LPT-30358AZMDPhysical Therapist
CP014479TWAMDPhysical Therapist
15753-24WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Post Acute Medical PLLC PastSince Aug 7, 2022 Accepting new patients
800 Medcalf Lane North Operations LLC PastSince Aug 7, 2022 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1647302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1992453310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 E WASHINGTON AVE APT 507",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537034413",
            "telephone_number": "845-978-3314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 MEDCALF ST",
            "city": "MONTESANO",
            "state": "WA",
            "postal_code": "985631300",
            "telephone_number": "360-249-2273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1010 E Washington Ave Apt 507",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "537034413",
            "country_code": "US",
            "telephone_number": "845-978-3314",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BRITTANY",
        "middle_name": "ANN",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-15",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "15753-24",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "CP014479T",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "LPT-30358",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montesano, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.