Jacklyn Kokuashvili
NPI 1407668064ActiveIndividual· Physical Therapist· Agoura Hills, CA
Physical Therapist with Athletic Physical Therapy Inc, practicing in Agoura Hills, California. Enrolled in Medicare as practitioner - physical therapist in private practice.
Overview
| NPI | 1407668064 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Sole proprietor | No |
| NPI issued | Jan 22, 2025 |
| Last updated in NPPES | Jan 22, 2025 |
| Certified by provider | Jan 21, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | 307149 | CA |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physical Therapist in Private Practice (CA) |
|---|
Education and affiliations
| Graduation year | 2024 |
|---|---|
| Medicare specialty | Physical Therapist In Private Practice |
Medical group
- Athletic Physical Therapy IncSimi Valley, CA · 10 clinicians
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All 25 physical therapists in Agoura Hills · All physical therapists in California