Individual provider Active NPI

Justin J Shelley, DPT

  • Physical Therapist
  • Kirkland, WA
National Provider Identifier
1053643205
Registry record updated Oct 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
36478 Issued in CA
Practice address
11800 NE 128TH Street
Suite 400
Kirkland, WA 98034-7299
Phone
(425) 820-0869
Fax
(425) 820-1745
NPI assigned
Feb 12, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 36478 CA Primary

Addresses

Primary practice location

11800 NE 128TH Street
Suite 400
Kirkland, WA 98034-7299

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121024000122 WA Practitioner - Physical Therapist in Private Practice 9032369285 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Peak Sports and Spine Physical Therapy Lake City PSGroup PAC ID 2163524182, 6 clinicians

Practice addresses (Care Compare)

11545 15TH Ave NE
Suite 205
Seattle, WA 98125-6358
Phone (206) 417-1298

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
36478CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Apple Physical Therapy, LLC Physical Therapist CurrentSince Jun 22, 2015 Accepting new patients
Peak Sports and Spine Physical Therapy Lake City PS Physical Therapist CurrentSince Jun 1, 2023 Accepting new patients
Apple Physical Therapy LLC Physical Therapist CurrentSince Jun 22, 2015 Accepting new patients
Movement Systems Physical Therapy, P.S. Physical Therapist CurrentSince Jul 29, 2019 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

4947 Paysphere Cir
Chicago, IL 60674
Phone (630) 783-2001

1188 106th Ave NE
Ste 100
Bellevue, WA 98004
Phone (425) 454-4864

32030 23rd Ave S
Federal Way, WA 98003
Phone (253) 946-4852

11800 NE 128th St
Ste 400
Kirkland, WA 98034
Phone (425) 820-0869

8435 SE 68th St
Ste 100
Mercer Island, WA 98040
Phone (206) 405-1864

11545 15th Ave NE
Ste 205
Seattle, WA 98125
Phone (206) 364-2010

1200 Westlake Ave N
Ste 100
Seattle, WA 98109
Phone (206) 405-1864

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1265932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445644800000",
    "number": "1053643205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11800 NE 128TH STREET",
            "address_2": "SUITE 400",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980347299",
            "telephone_number": "425-820-0869",
            "fax_number": "425-820-1745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELLEY",
        "first_name": "JUSTIN",
        "middle_name": "J",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-02-12",
        "last_updated": "2015-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "36478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.