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

Jacklyn Kokuashvili

Individual provider Physical Therapist · NPI 1407668064

Jacklyn Kokuashvili is a Physical Therapist in Private Practice in Agoura Hills, California. Qualified in 2024, 2 years ago. Practices with Athletic Physical Therapy Inc, a 10-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
2
Licensed in
CA
In the registry since
2025
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Practice location Address checks out

30851 Agoura Rd Ste 300A
Agoura Hills, CA 91301-4346
Phone: (818) 532-7600
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 307149 (CA)

Record details

NPI number1407668064
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJanuary 22, 2025
Last updated in NPPESJanuary 22, 2025
Certification dateJanuary 21, 2025
Mailing address5301 Via Pisa, Newbury Park, CA 91320-7007

Medicare enrollment

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

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Athletic Physical Therapy Inc — 10 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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