Healthcare Provider Details

I. General information

NPI: 1932647963
Provider Name (Legal Business Name): JASON SACKETT WEST DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2017
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BRULE ST BLDG 871
FORT KNOX KY
40121-6100
US

IV. Provider business mailing address

1212 WEST VALLEY DRIVE
HENRICO VA
23229
US

V. Phone/Fax

Practice location:
  • Phone: 800-493-9602
  • Fax:
Mailing address:
  • Phone: 804-971-4265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305215575
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: