Mackenzie Nicole Jackson, PT, DPT
Physical Therapist in Puyallup, WA. Individual provider (NPI-1).
NPI number1356955751
StatusActive
Last updated in NPPESAug 5, 2025
Details
- NPI
- 1356955751
- Entity type
- Individual (NPI-1)
- Name
- Mackenzie Nicole Jackson
- Credential
- PT, DPT
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 2, 2020
- Certification date
- Aug 5, 2025
- Last updated
- Aug 5, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICAL THERAPIST IN PRIVATE PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225100000X | Physical Therapist | PT61528942 | WA | Yes |
| 225100000X | Physical Therapist | 5501019681 | MI |
Practice location
11212 Sunrise Blvd E Ste 202Puyallup, WA 98374-8847
Phone 253-435-0360 · Fax 253-435-0325
Mailing address
11212 Sunrise Blvd E Ste 202Puyallup, WA 98374-8847
Phone 253-435-0360 · Fax 253-435-0325
Other practice locations
552 S Paseo Dorotea Ste 4
Palm Springs, CA 92264-1437
Palm Springs, CA 92264-1437
Phone 760-325-5950 · Fax 760-325-5945
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 225 Physical Therapist providers in Puyallup · All 4,232 providers in Puyallup
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