MISS JACKALYN NICOLE PETERSON DPT
NPI 1013241769
Specialist in Fairfax, VA

Q: What is Jackalyn Peterson's NPI number?

The NPI number for Jackalyn Peterson is 1013241769. It was assigned to this individual provider in the NPPES registry on September 29, 2009.

Q: What is Jackalyn Peterson's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Q: When was this NPI record last updated?

The NPPES record for Jackalyn Peterson was last updated on November 14, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since September 29, 2009Accepts Medicare Assignment

9860 FAIRFAX BLVD, SUITE 1, FAIRFAX, VA 22030(703) 383-1616(703) 383-1166 Get Directions Write a Review

NPPES record last updated: November 14, 2016. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Miss Jackalyn Nicole Peterson Dpt NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MISS JACKALYN NICOLE PETERSON DPT (NPI 1013241769) is an individual specialist in Fairfax, Virginia, licensed in Virginia (2305206191) and active in the NPI registry since September 2009. She is a graduate of Other (2009).

NPPES Registry Identity

NPI1013241769

Entity TypeIndividualFemale

Primary Taxonomy174400000X

Provider Legal NameMISS JACKALYN NICOLE PETERSONCredential: DPT

Location Address9860 FAIRFAX BLVD, SUITE 1Fairfax, VA 22030-1737

Mailing Address9860 Fairfax Blvd, Suite 1Fairfax, VA 22030-1737 · (703) 383-1616 · Fax (703) 383-1166

Phone(703) 383-1616

Fax(703) 383-1166

Sole ProprietorNo

Medical School CMSOtherGraduated 2009

Enumeration DateSeptember 29, 2009

Last NPPES UpdateNovember 14, 2016

✔ NPI 1013241769 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers

Taxonomy Code174400000X

License✔ Licensed in VA · 2305206191

Definition

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

9860 FAIRFAX BLVD, Fairfax, VA 22030

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Miss Jackalyn Nicole Peterson Dpt is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1355488107

PECOS Enrollment IDI20191126003266

Medicare Billing Reassignment

Medicare enrollment records show Jackalyn Peterson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Excel Rehabilitation, PLLC

1.4 mi

Specialist

10521 ROSEHAVEN ST STE LL150
Fairfax, VA 22030

Reassigned Medicare billing, District of Columbia and Virginia enrollments
9 clinicians in this Medicare group

NPI 1922091032 (703) 383-1616

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 6

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes 97112

This therapy helps retrain your brain, nerves, and muscles to work together. Through targeted exercises, your body learns to regain lost functions or improve current abilities. Each session lasts 15 minutes.

167 services22 patients

Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes 97110

This therapy involves exercises to boost strength, endurance, flexibility, and range of motion. Each session lasts 15 minutes. The goal is to improve physical function and overall health. It's a safe, beneficial method for enhancing well-being and fitness.

160 services22 patients

Therapy procedure using functional activities 97530

A therapy procedure using functional activities encourages you to use your own body movements in day-to-day tasks to aid recovery. It aims to improve your mobility, strength, and overall health by incorporating therapeutic exercises into your routine.

154 services18 patients

Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care G0283

Electrical stimulation is a therapy method where mild electrical pulses are used to treat pain or stimulate muscles in certain areas. It's not for wound care but is part of a broader therapy plan. It's safe, non-invasive, and can help improve overall health.

137 services19 patients

Therapy procedure in a group setting 97150

Group therapy involves meeting with a trained therapist alongside others facing similar challenges. It provides a supportive environment to share experiences, learn coping strategies, and gain insights from others. It's a safe space for personal growth and mutual support.

95 services25 patients

Therapy procedure using manual technique, each 15 minutes 97140

This therapy involves using hands-on techniques to help improve your body's movement and function. These techniques may include stretching, resistance exercises, or gentle pressure. Each session lasts 15 minutes and aims to relieve pain, promote healing, and improve your overall health.

51 services11 patients

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. CHRISTINE PETERSON DPT

Specialist

9860 FAIRFAX BLVD, SUITE 1
FAIRFAX, VA 22030

Fairfax City (703) 383-1616

APRIL A MUNOZ DPT

Physical Therapist

9860 FAIRFAX BLVD, #1
FAIRFAX, VA 22030

Fairfax City (703) 383-1616

MRS. WANDA EDWARDS GROVE PT

Physical Therapist

9860 FAIRFAX BLVD, SUITE 1
FAIRFAX, VA 22030

Fairfax City (703) 383-1616

DANIELLE LEBER PT

Physical Therapist

9860 FAIRFAX BLVD, SUITE 1
FAIRFAX, VA 22030

Fairfax City (703) 383-1616

ERIN M BURFORD DPT, PT

Specialist

9860 FAIRFAX BLVD, SUITE 1
FAIRFAX, VA 22030

Fairfax City (703) 383-1616

MRS. AMY ELIZABETH CAMPBELL MSPT

Specialist

9860 FAIRFAX BLVD, SUITE 1
FAIRFAX, VA 22030

Fairfax City (703) 383-1616

KAREN M GALLAGHER DPT

Physical Therapist

9860 FAIRFAX BLVD, SUITE 1
FAIRFAX, VA 22030

Fairfax City (703) 383-1616

MR. DUNCAN WILLIAM GERHARD DPT

Specialist

9860 FAIRFAX BLVD, SUITE 1
FAIRFAX, VA 22030

Fairfax City (703) 383-1616

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jackalyn Peterson's NPI number?

The NPI number for Jackalyn Peterson is 1013241769. It was assigned to this individual provider in the NPPES registry on September 29, 2009.

Where is Jackalyn Peterson located?

Jackalyn Peterson practices at 9860 Fairfax Blvd Suite 1, Fairfax, VA 22030. The listed phone number is (703) 383-1616.

What is Jackalyn Peterson's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Jackalyn Peterson enrolled in Medicare?

Yes. Jackalyn Peterson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Jackalyn Peterson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jackalyn Peterson reassigns Medicare benefits to Excel Rehabilitation, PLLC (Fairfax, VA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jackalyn Peterson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jackalyn Peterson was last updated on November 14, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.