KATHY JACKSON (PT) – Physical Therapist, NPI 1811060379

KATHY JACKSON (PT) is a healthcare provider. based in Mayo, Florida. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. They hold the professional credentials PT. They hold a License No. PT17158 (FL). The NPI Number for KATHY JACKSON (PT) is 1811060379

Main info

Female
29 Years Of Experience
Accepts Medicare Assignment
Name
KATHY JACKSON (PT)
NPI
1811060379
Phone
(386) 658-5865
Address
373 NE GID JACKSON LN
Enumeration Date
15 November 2006
Last Update Date
8 July 2007

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3866585450
Graduation Year
1997 (29 years ago)
PAC ID
9133209927
Group Practice PAC ID
3476462078
Professional Enrollment ID
I20080107000364
Address ID
FL320603714LI10820BLVD400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience52
Completeness75
Years active:19State licenses:1Digital endpointsOther names

4,633 PHYSICAL THERAPIST IN PRIVATE PRACTICE in FL

Provider Addresses for KATHY JACKSON (PT)

  • 373 NE GID JACKSON LN

    MAYO, FL 32066

    Phone: (386) 658-5865

    Fax: (386) 658-5542

    Type: Mailing

  • 10820 MARVIN E. JONES BLVD.

    LIVE OAK, FL 32060

    Phone: (386) 658-5865

    Fax: (386) 658-5542

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2008-01-07

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20080107000364IPhysical Therapist In Private PracticeFLTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
97110Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes52239$0
97161Evaluation for physical therapy, typically 20 minutes2422$0
View full utilization report →

Insurance plans in this area (ZIP 32066)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 3476462078View full group profile
NameSpecialtyState
-SC
Nurse PractitionerFL
Nurse PractitionerPA
Nurse PractitionerFL
Qualified Speech Language PathologistPA
Nurse PractitionerFL
-NY
Family PracticeMN
Occupational Therapist In Private PracticeFL

Reviews

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Frequently asked questions

Can I use this page to confirm KATHY JACKSON (PT)'s NPI?
Yes. KATHY JACKSON (PT) is listed with NPI 1811060379 in the public NPI dataset.
Does CMS list KATHY JACKSON (PT) as active?
Yes — KATHY JACKSON (PT) is active in the NPI listing used on this page.
What taxonomy line describes KATHY JACKSON (PT)?
For research purposes, treat KATHY JACKSON (PT) as Physical Therapist in this dataset. Clinical services aligned with this taxonomy classification.
Where should I expect KATHY JACKSON (PT) on a map?
Expect Mayo, Florida as a primary anchor for KATHY JACKSON (PT) unless the record lists multiple sites.
Why does KATHY JACKSON (PT) have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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