Jennifer Sullivan Bullock, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1081933 Issued in TX

Practice address

622 Mountain Village Blvd Ste 102
Mountain Village, CO 81435-9529

Phone

(214) 864-2440

NPI assigned

Sep 27, 2018

Last updated

Sep 27, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO, TX2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

University of Texas Medical Branch at Galveston, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Transformation Therapeutics, PLLC

  • Physical Therapy Clinic/Center
  • Mountain Village, CO
  • NPI 1679042121

  Physical Therapist

  Medicare reassignment NPD Authorized official
• Transformation Physical Therapy LLC

  • Physical Therapist
  • Coppell, TX
  • NPI 1992460174
  Medicare reassignment NPD Authorized official
• Balanced Therapy LLC

  • Physical Therapy Clinic/Center
  • Mountain Village, CO
  • NPI 1164644605
  NPD

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

{
    "created_epoch": "1538006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538006400000",
    "number": "1164907986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "870 FOXDALE",
            "city": "FAIRVIEW",
            "state": "TX",
            "postal_code": "750698794",
            "telephone_number": "214-864-2440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 MOUNTAIN VILLAGE BLVD STE 102",
            "city": "MOUNTAIN VILLAGE",
            "state": "CO",
            "postal_code": "814359529",
            "telephone_number": "214-864-2440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "JENNIFER",
        "middle_name": "SULLIVAN",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-27",
        "last_updated": "2018-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1081933",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Balanced Therapy LLC
• Transformation Therapeutics, PLLC
• Derek C Tuohy, MSPT, CSCS

• Physical Therapist in Mountain Village, CO
• Providers in Mountain Village, CO by specialty
• Physical Therapist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2018; 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.