Individual provider Active NPI

Jessica Carlson, PT, DPT

  • Physical Therapist
  • Tempe, AZ
National Provider Identifier
1184204646
Registry record updated Aug 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
31700 Issued in AZ
Practice address
1 W Elliot Rd Ste 109
Tempe, AZ 85284-1310
Phone
(480) 374-4341
NPI assigned
Apr 9, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2026

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 31700 AZ Primary

Addresses

Primary practice location

1 W Elliot Rd Ste 109
Tempe, AZ 85284-1310

Mailing address

1037 E Diana Ave
Phoenix, AZ 85020-3223
Phone (805) 458-4267

Other names 1

  • Jessica Kelly Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210428003065 AZ Practitioner - Physical Therapist in Private Practice 8224447420 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
31700AZMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ati Holdings of Arizona, LLC Physical Therapist CurrentSince Apr 19, 2021 Accepting new patients
Ideal Rehabilitation LLC Past Accepting new patients
Mariposa Speech Services LLC Physical Therapist PastSince Jul 25, 2019 Accepting new patients

Locations

1485 E Florence Blvd
Ste 105
Casa Grande, AZ 85122
Phone (520) 494-3058

11209 N Tatum Blvd
Ste B120
Phoenix, AZ 85028
Phone (602) 595-0204

6339 E Greenway Rd
Ste 102
Scottsdale, AZ 85254
Phone (480) 482-2842

1020 S Harrison Rd
Unit 120
Tucson, AZ 85748
Phone (520) 207-6288

790 Remington Blvd
Bolingbrook, IL 60440

Organizations & group practices 3

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": "1617926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786665600000",
    "number": "1184204646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1037 E DIANA AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850203223",
            "telephone_number": "805-458-4267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 W ELLIOT RD STE 109",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852841310",
            "telephone_number": "480-374-4341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "JESSICA",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-09",
        "last_updated": "2026-08-14",
        "certification_date": "2026-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "31700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "KELLY",
            "credential": "PT, DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tempe, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.