Active NPI
Tiffany Rachelle Shull, PTA
- Physical Therapy Assistant
- Arcola, IL
National Provider Identifier
1144701749
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 160.007953
- Practice address
- 909 Green Mill Rd
Arcola, IL 61910-3527 - Phone
- (217) 268-3516
- NPI assigned
- Aug 22, 2018
- 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 Therapy Assistant | 225200000X | 160.007953 | IL | Primary |
Addresses
Primary practice location
909 Green Mill Rd
Arcola, IL 61910-3527
Mailing address
308 N Missouri St
Toledo, IL 62468-1001
Phone (217) 821-2065
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 |
|---|---|---|---|
| 160.007953 | IL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534896000000",
"number": "1144701749",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "308 N MISSOURI ST",
"city": "TOLEDO",
"state": "IL",
"postal_code": "624681001",
"telephone_number": "217-821-2065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "909 GREEN MILL RD",
"city": "ARCOLA",
"state": "IL",
"postal_code": "619103527",
"telephone_number": "217-268-3516"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHULL",
"first_name": "TIFFANY",
"middle_name": "RACHELLE",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-22",
"last_updated": "2018-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IL",
"license": "160.007953",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arcola, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.