Active NPI
Jeffrey M Petrik, PT
- Physical Therapist
- Sun Lakes, AZ
National Provider Identifier
1033466768
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1491
- Practice address
- 25229 S Sun Lakes Blvd
119
Sun Lakes, AZ 85248-6453 - Phone
- (480) 883-6734
- Fax
- (480) 895-8143
- NPI assigned
- Aug 13, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1491 | AZ | Primary |
Addresses
Primary practice location
25229 S Sun Lakes Blvd
119
Sun Lakes, AZ 85248-6453
Mailing address
25229 S Sun Lakes Blvd
119
Sun Lakes, AZ 85248-6453
Phone (480) 883-6734
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1491 | AZ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344816000000",
"number": "1033466768",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25229 S SUN LAKES BLVD",
"address_2": "119",
"city": "SUN LAKES",
"state": "AZ",
"postal_code": "852486453",
"telephone_number": "480-883-6734",
"fax_number": "480-895-8143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25229 S SUN LAKES BLVD",
"address_2": "119",
"city": "SUN LAKES",
"state": "AZ",
"postal_code": "852486453",
"telephone_number": "480-883-6734",
"fax_number": "480-895-8143"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRIK",
"first_name": "JEFFREY",
"middle_name": "M",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-08-13",
"last_updated": "2012-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "1491",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sun Lakes, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.