Jacklyn Kokuashvili, in Agoura Hills, CA - Medicare Physical Therapist Provider

Jacklyn Kokuashvili, is a medicare enrolled "Physical Therapist" provider in Agoura Hills, California. Her current practice location is 30851 Agoura Rd Ste 300a, Agoura Hills, California. You can reach out to her office (for appointments etc.) via phone at (818) 532-7600.

Jacklyn Kokuashvili is licensed to practice in California (license number 307149) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1407668064.

Contact Information

	Jacklyn Kokuashvili,
	30851 Agoura Rd Ste 300a, Agoura Hills, CA 91301-4346
	(818) 532-7600
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Jacklyn Kokuashvili
Gender	Female
Speciality	Physical Therapist
Location	30851 Agoura Rd Ste 300a, Agoura Hills, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1407668064
Provider Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025

Medicare PECOS Information:

PECOS PAC ID: 3173043692
Enrollment ID: I20250226003636

Medical Identifiers

Medical identifiers for Jacklyn Kokuashvili such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1407668064	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
225100000X	Physical Therapist	307149 (California)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jacklyn Kokuashvili allows following entities to bill medicare on her behalf.

Provider Name	Athletic Physical Therapy Inc
Provider Type	Part B Supplier - Clinic/group Practice
Provider Identifiers	NPI Number: 1114042165 PECOS PAC ID: 6507821436 Enrollment ID: O20041202000150

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jacklyn Kokuashvili is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Jacklyn Kokuashvili, 5301 Via Pisa, Newbury Park, CA 91320-7007 Ph: () -	Jacklyn Kokuashvili, 30851 Agoura Rd Ste 300a, Agoura Hills, CA 91301-4346 Ph: (818) 532-7600

Reviews and Comments

Physical Therapist in Agoura Hills, CA

A5 Physical Therapy Services Pc Physical Therapist Medicare: Medicare Enrolled Practice Location: 29219 Canwood St # 107, Agoura Hills, CA 91301 Phone: 617-605-0295
A5 Physical Therapy Inc Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 29219 Canwood St Unit 107, Agoura Hills, CA 91301 Phone: 818-914-7559 Fax: 818-914-7560
Mrs. Michele Alden Zeolla, PHYSICAL THERAPIST Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 5927 Kanan Road, Agoura Hills, CA 91301 Phone: 818-889-0158 Fax: 818-889-4708
Lianne Elizabeth Messier, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 30135 Agoura Rd, Suite C, Agoura Hills, CA 91301 Phone: 818-707-7344
Robert N Mettam Pt And Timothy P Everitt Pt Physical Therapists Inc Physical Therapist Medicare: Medicare Enrolled Practice Location: 30135 Agoura Rd Ste C, Agoura Hills, CA 91301 Phone: 818-707-7344 Fax: 818-707-7133
Genevieve Brando, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 5927 Kanan Rd, Agoura Hills, CA 91301 Phone: 818-889-0158

Jacklyn Kokuashvili, - Medicare Physical Therapist in Agoura Hills, CA