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

Jackson Darveaux

Individual provider Physical Therapist · NPI 1669125191

Jackson Darveaux is a Physical Therapist in Private Practice in Phoenix, Arizona. Qualified in 2021, 5 years ago. Practices with Physio Shop Flagstaff LLC, a 6-clinician group and accepts Medicare assignment.

Years since qualifying
5
In the registry since
2022
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Practice location Address checks out

7540 N 19th Ave
Phoenix, AZ 85021-7967
Phone: (888) 873-4221
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X

Record details

NPI number1669125191
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedFebruary 3, 2022
Last updated in NPPESFebruary 3, 2022
Certification dateFebruary 3, 2022
Mailing address7540 N 19th Ave, Phoenix, AZ 85021-7967

Medicare enrollment

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

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Physio Shop Flagstaff Llc — 6 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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