Active NPI
Jessica Sue Costakes, PT
- Physical Therapist
- St Augustine, FL
National Provider Identifier
1992814545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 190 Southpark Blvd
Suite 100
St Augustine, FL 32086-4120 - Phone
- (904) 824-1478
- NPI assigned
- Aug 29, 2006
- Sex
- Female
- Sole proprietor
- No
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 | Primary |
Addresses
Primary practice location
190 Southpark Blvd
Suite 100
St Augustine, FL 32086-4120
Mailing address
3572 Marlinspike Dr
Tampa, FL 33607-5871
Phone (517) 214-2713
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 891952600 | Medicaid | FL | |
| PT 22531 | Other | FL | LICENSE# |
Other names 1
- Jessica Sue Keck
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)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Genesis Rehabilitation Hospital, Inc. | Past | Accepting new patients | |
| Genesis Rehabilitation Hospital, Inc. | Past | 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.
-
- Rehabilitation Hospital
- Jacksonville, FL
- NPI 1376114413
-
- Rehabilitation Hospital
- Jacksonville, FL
- NPI 1912947748
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223337600000",
"number": "1992814545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3572 MARLINSPIKE DR",
"city": "TAMPA",
"state": "FL",
"postal_code": "336075871",
"telephone_number": "517-214-2713"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "190 SOUTHPARK BLVD",
"address_2": "SUITE 100",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320864120",
"telephone_number": "904-824-1478"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COSTAKES",
"first_name": "JESSICA",
"middle_name": "SUE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-29",
"last_updated": "2008-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "891952600",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE#",
"identifier": "PT 22531",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JESSICA",
"last_name": "KECK",
"middle_name": "SUE",
"credential": "PT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in St Augustine, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.