MICHAEL GENE JACKETTA (NPI# 1134131055) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134131055 |
| Entity Type | Individual |
| Full Name | MICHAEL GENE JACKETTA |
| Credential | MPT, OCS |
| Practice Address |
620 West Cheyenne Drive Evanston WY 82930-5359 |
| Practice Telephone | 3077898860 |
| Practice Fax Number | 3077898394 |
| Mailing Telephone | 3077898860 |
| Mailing Fax Number | 3077898394 |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225100000X | Physical Therapist | 840 | WY | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WY | 117012100 118279000 | 05 |
| Street Address |
620 WEST CHEYENNE DRIVE |
| City | EVANSTON |
| State | WY |
| Zip Code | 82930-5359 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598398935 | Colby Kim Gomez | Physical Therapist | 190 Arrowhead Dr, Evanston, Wy 82930, Evanston, WY 82930 | 2020-02-13 |
| 1164808382 | Marilyn Carol Edgeworth Tacoma | Registered Nurse | 1037 Morse Lee St, Evanston, WY 82930 | 2015-08-11 |
| 1699159723 | Impact Physical Therapy LLC | Clinic/Center | 96 Yellow Creek Road, Evanston, WY 82930 | 2015-07-18 |
| 1578942421 | Mark Carstensen | Case Manager/Care Coordinator | 219 7th Street, Evanston, WY 82930 | 2015-05-26 |
| 1013396241 | Jennifer Carstensen | Case Manager/Care Coordinator | 325 Arrowhead Drive, Evanston, WY 82930 | 2015-05-20 |
| 1780083782 | Christa Lena Barker | Nurse Practitioner | 191 Overthrust Road, Evanston, WY 82930 | 2014-08-15 |
| 1366865339 | Don Mckay Francom | Dentist | 170 Arrowhead Dr. Suite 1, Evanston, WY 82930 | 2014-01-28 |
| 1417228370 | Premier Surgical Center, LLC | Clinic/Center | 195 Overthrust Road, Evanston, WY 82930 | 2012-01-24 |
| 1588959324 | Mejia D Williams | Social Worker | 190 Overthrust Road, Evanston, WY 82930 | 2011-06-09 |
| 1225327000 | Richard Jay Capener | Family Medicine | 196 Arrowhead Dr Ste 1, Evanston, WY 82930 | 2011-04-01 |
| Find all providers in zip 82930 | ||||
| Taxonomy Code | 225100000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT’s assess joint motion, muscle strength and endurance, function of heart and lungs, and performance of activities required in daily living, among other responsibilities. Treatment includes therapeutic exercises, cardiovascular endurance training, and training in activities of daily living. (2) A physical therapist is a person qualified by an accredited program in physical therapy, licensed by the state, and practicing within the scope of that license. Physical therapists treat disease, injury, or loss of a bodily part by physical means, such as the application of light, heat, cold, water, electricity, massage and exercise. They develop treatment plans based upon each patient’s strengths, weaknesses, range of motion and ability to function. (3) A health professional who specializes in physical therapy- the health care field concerned primarily with the treatment of disorders with physical agents and methods, such as massage, manipulation, therapeutic exercises, cold, heat (including short-wave, microwave, and ultrasonic diathermy), hydrotherapy, electric stimulation and light to assist in rehabilitating patients and in restoring normal function after an illness or injury. |
| Notes: Source: (1) APTA Guidelines for Physical Therapy Claims Review, American Physical Therapy Association. (3) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 612 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982211553 | Allyson Nortz | Physical Therapist | 3238 Harrison St, Evanston, IL 60201-1165 | 2020-09-28 |
| 1598398935 | Colby Kim Gomez | Physical Therapist | 190 Arrowhead Dr, Evanston, Wy 82930, Evanston, WY 82930 | 2020-02-13 |
| 1154978211 | Jennifer Ann Kamm | Physical Therapist | 2617 Central St, Evanston, IL 60201-6412 | 2019-08-23 |
| 1851853006 | Amelia Sharmaine Longsworth | Physical Therapist | 813 Washington St Apt 1n, Evanston, IL 60202-2261 | 2019-04-04 |
| 1437660156 | Joseph Victor Kopke | Physical Therapist | 1021 South Blvd Apt 1, Evanston, IL 60202-2702 | 2017-10-20 |
| 1851819403 | Joshua Dean Koutas | Physical Therapist | 805 Davis Street, Evanston, IL 60201 | 2017-09-05 |
| 1073066122 | Aime Maranan | Physical Therapist | 839 Dodge Ave, Evanston, IL 60202-1552 | 2016-07-25 |
| 1316283450 | Matthew Dennis Mitchell | Physical Therapist | 196 Arrowhead Dr Ste 3, Evanston, WY 82930-8752 | 2012-12-18 |
| 1669753497 | Athletic and Therapeutic Institute of Naperville, LLC | Physical Therapist | 805 Davis St, Evanston, IL 60201-4401 | 2011-09-07 |
| 1538469341 | Jennifer Barnes | Physical Therapist | 8930 Forestview Rd, Evanston, IL 60203-1911 | 2010-10-26 |
| Find all providers in EVANSTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.