Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Corey Jackson, DPT

Individual provider Physical Therapist · NPI 1154735611

Corey Jackson, DPT is a Physical Therapist in Private Practice in Wichita, Kansas. Qualified in 2014, 12 years ago. Practices with Advanced PT LLC, a 84-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Kansas.

Years since qualifying
12
Licensed in
KS
In the registry since
2014
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

3460 N Ridge Rd Ste 80
Wichita, KS 67205-1223
Phone: (316) 202-0340
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1551 N Rock Rd, Wichita, KS 67206-1255 — (316) 858-1885

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 11-04877 (KS)

Record details

NPI number1154735611
Entity typeIndividual (Type 1)
GenderMale
Credentials DPT
Sole proprietorNo
NPI enumeratedJune 12, 2014
Last updated in NPPESSeptember 27, 2023
Certification dateSeptember 27, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Advanced Pt Llc — 84 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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