Active NPI
Jill Carla Shough, PT
- Physical Therapist
- Glendale, AZ
National Provider Identifier
1093443608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2559
- Practice address
- 4650 W Sweetwater Ave
Glendale, AZ 85304-1505 - Phone
- (602) 347-4893
- NPI assigned
- Aug 11, 2022
- Sex
- Female
- Sole proprietor
- No
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 | 2559 | AZ | Primary |
Addresses
Primary practice location
4650 W Sweetwater Ave
Glendale, AZ 85304-1505
Mailing address
4650 W Sweetwater Ave
Glendale, AZ 85304-1505
Phone (602) 347-4893
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2559 | AZ | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1660176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660176000000",
"number": "1093443608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4650 W SWEETWATER AVE",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853041505",
"telephone_number": "602-347-4893"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4650 W SWEETWATER AVE",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853041505",
"telephone_number": "602-347-4893"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHOUGH",
"first_name": "JILL",
"middle_name": "CARLA",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-08-11",
"last_updated": "2022-08-11",
"certification_date": "2022-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "2559",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.